443- Exploring Manual Manipulation and Its Effects on Gait

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. This week we are back with more brand new research. I'll be sure to drop a link down in the show notes to the study. It is titled effect of manual manipulation on mechanical gait parameters. We're gonna dive into the study, the take home messages, the clinical pearls and much more all on today's episode. But before we get there, I wanna say a few words about Patient Pilot. In about a month we are gonna have a grand reveal release of Patient Navigator that lives within Patient Pilot. There is a lot to be said about it. I'm gonna save it for a future episode. But keep your eyes on your emails for a special invite. If you are on our email list, you're gonna receive an invite to the launch party. All the details will be forthcoming. But if you wanna check things out right now with what's going on in Patient Pilot and Smart Chiropractor it's all about patient reactivations. You can learn more at the Smart Chiropractor the and pin your calendar for July where we're going to go into Patient Navigator. But as I said at the top on today's episode it's all about research. The effect of manual manipulation on mechanical gate parameters. This came out in 2024, just this year. And they define manual manipulation as what they call an adjunctive therapy. And when they talk about it they highlight the fact that it can be performed by a variety of different provider typ with ultimately goals that we are very familiar with. Relieving pain, improving physical function, decreasing the disease burden. For patients that have neuromusculoskeletal challenges. They highlight the fact that manual manipulation has been shown to be cost effective and to be very effective in terms of clinical outcomes for musculoskeletal conditions compared with general practitioner care. That's really, really important in my mind with what I've seen in the literature and the research. There is absolutely no question at any point in time for the last few years that compared to general medical care, movement based health care dominates in terms of the ability to help get people well and help people stay well and movement based healthcare, obviously a landmark and icon within that realm you is spinal adjustments, manual manipulation, however you want to say it now. They highlight the fact that manual manipulation could include things like osteopathic treatment, chiropractic manipulation. They even loop in massage joint mobilization. So they give a rather wide berth to what they're referring to as manual manipulation in this study. But it all revolves around movement, which is critical. Systematic reviews have shown. We've highlighted tons of them on this podcast. The clinical benefits of chiropractic adjustments or manipulation for patients with low back pain and neck pain. We've also seen the emerging research in terms of performance benefits, etc. But in this study, they were specifically looking at gait. Gait is the state of walking, as we know, and it is unbelievably complex. We think about, well, you know, you learn how to do it at a young age, and you kind of can do it until you're really, really old at the end. But it is ridiculously complex. It involves the integration of sensory information that coming from the vestibular systems, the visual systems, the somatosensory systems. It involves cortical integration of that sensory input with motor output, with pattern generation, with reflex systems, with complex functions. Getting up and walking around is exceedingly complex. It is bidirectional, meaning there is input coming in, motor function going out, and it's crazy dynamic. When you think about just walking, nothing is exactly even and level, and nor is the horizon line. And your brain and body's ability to manage that essentially thoughtlessly is incredible. So manual therapy has been shown previously to improve overall posture. This can impact things like head position, thoracic kyphosis, pelvic position. It also can impact and influence postural stability, balance, range of motion, and strength. Now, all of these changes, influences, improvements that happen through manipulation can of course, then impact motor unit behavior, cortical drive, cortical processing, sensory motor integration, motor control, joint position, sense, all of those items, which is really interesting because when you think about manipulation or an adjustment being delivered, again, they're using manual manipulation, which encounters or encapsulates more than just a chiropractic adjustment with massage, osteopathic treatment, et cetera. But there's a lot that goes on when touch is involved, when movement is involved. A lot happens through input and output. And this study was looking at how can this impact gait. We've seen improvement with manual manipulation in terms of osteoarthritis in the knee that could alter gait. So they say it's reasonable to expect that manual manipulation could positively influence gait patterns. Now, why is this a big deal? Well, it's a big deal probably for a Lot of reasons you see in your practice each and every day. So as we get older, our gait speed typically decreases and gait speed is a really, really strong indicator of long term health outcomes. Why? Because when you have slower gait speed, you can have impaired activities of daily living. It can be a predictor of health related quality of life. It can impact mobility and even has some correlation with depressive symptoms because of the risk of falls, because of the impact on quality of life, because of the inability to do the things that people want to do with the people that they love. And if you've had normal gait throughout your entire life, a slowing of gait speed can have a really compounding snowball effect on your ability to really get out there and enjoy life. Gait also plays a really, really important role in injury progression. This involves lower extremities, hips, back, all of which are affected. And this is where this study starts to get, I'm going to say chiropractic focused in terms of our terminology. All of that is affected by symmetry and magnitude of force with every single step. As I like to say, gravity and time are undefeated. Everybody is under constant load throughout their entire life, every. And gravity and time are just plain undefeated. So the question then becomes, well, what can you do to positively mitigate those effects? Because you can't eliminate them, you can't take away gravity, you can't take away time. But what you can do is make great decisions today for your future health tomorrow. This looked at a variety of studies in this study and they found 12 of 20 that had a significant effect of manipulation on gait parameters. They highlighted previous studies showing a positive clinical effect of five sessions of manual therapy in patients with low back pain and a weak trend towards symmetrical gait. They looked at another study that demonstrated increases in cadence, stride length and speed amongst individuals who had previously had a stroke after a single session of joint mobilization or stretching. The they also had a healthy patient population with limited ankle dorsiflexion range of motion. And they saw after a single session of joint mobilization, an increased time to heal off during that gait pattern. And they also highlighted another study that compared the effect of one session of whole body osteopathic manipulation to neck down to sham treatment for people who had Parkinson's. And they reported improved range of motion in the whole body treatment group and no significant differences in the gait parameters. So this study really was encompassing a variety of previous literature to highlight basically, what do we know today? How does manual manipulation affect gait patterns? If at all. And how can we utilize this? I always think about from a communication standpoint, but they're looking at it from a clinical relevancy standpoint. So there were significant changes highlighted additionally in a previous study around gait parameters and clinical measures with women with knee osteoarthritis after 12 sessions of Swedish massage. So getting in there, doing that soft tissue work, really, really, really important. Ultimately, the key takeaways from this study were that the reviews are mixed, meaning there is a variety of benefits highlighted in a variety of different studies showcasing the effect that manual manipulation can have upon gait patterns. However, they basically highlight the fact of it's mixed. And there hasn't been really a fantastic study that puts this together with the specificity and I'm going to say the power to make the strong recommendation. So what can we take away now in terms of what this study highlights? I think there's a couple things that we can take away. One is that when we consider, and I'll talk about spinal adjustments first, I always think in terms of segmental, regional and whole body movement. And if your segmental movement is dysfunctional, good luck with regional. Good luck with whole body. It's impossible. You'll be compensating the entire time. If your segmental motion is good, but your regional motion is bad, you're gonna have trouble with whole body motion. If you have whole body motion issues, well. Well, everything's gonna cascade from there. So understanding that balance, symmetry and load over time, everybody can get away with something, so to speak. Our bodies are super dynamic. You can have a compensatory pattern for a short period of time and have no big deal. That would be an acute injury, right? And an acute injury, you wanna prevent it from becoming chronic. Why? Because when there's chronic injury, chronic pain, chronic dysfunction, now you end up with chronic imbalances, chronic asymmetrical load. And this is where I'm going to say time and gravity accelerate rather than decelerate. Now, we obviously can't accelerate time or decelerate time, but I think you know what I'm saying in terms of you can play with the impact that time and gravity has and you can make things worse, so to speak. And we've all seen this. Individuals that are young, and maybe you take a look at an X ray or an mri, and based upon how they've lived their life, based upon injuries that they've had a variety of different Factors, they look 25 years older on their imaging than they actually are, sometimes 30 years older. And we've all seen the opposite. I'm sure you've seen where you've had patients that are maybe in their 60s or 70s, that the imaging might look as though they're in their 30s or 40s. And imaging is a great way to analyze structurally what's going on. Now, of course, you, your examination and evaluation play a role in that. To see really those movement patterns, no matter how you address those DNS, SFMA through range of motion testing, however you go about that in your practice, understanding that asymmetrical load over time can create advanced challenges or accelerate the aging process is really, really important. Now, pulling that back to gait parameters, I think about things from a spinal perspective first, personally, but. But I also could extend that thinking to the extremities, as I was taught and I believe in wholeheartedly. When you see an area of a person that had a joint issue with a person, always check the next joint or the next two joints. So if somebody has hip dysfunction, be sure to check the knee. If they have low back pain, check the hip and the knee. If they have ankle issues, be sure to check the knee. Right. All of these things play into gait parameters. Gait can be highly affected by low back issues, of course, by hip knee, ankle issues, amongst some other things. But those are primary items that you want to take a look at understanding, circling back around and understanding that if gait patterns are disturbed, if segmental biomechanics are compromised, that can result in negative ramifications for, for that individual long term. So it stands to reason the opposite way, which I agree with, that the sooner you can take care of imbalances, movement patterns that are asymmetrical, dysfunctional, disturbed, and joint position has a lot to do with this. The sooner that you can address those with the patient, the more you are heading off at the past, a potential challenge in the future, and an ideal state, somebody that's moving, symmetrically, moving, well, great awareness, great segmental, regional and whole body motion should be able to, quote, unquote, slow down the aging process. Why? Because the aging process predominantly, yes, there's a cellular chemical component to it, but there's a lot of it that has to do with load and time. So that is my big takeaways from this study. I'm excited to see where this goes in the future because as they point out, hey, things are a little mixed right now in terms of the direct effects. And let's get some more research highlighting specific modalities. So I think there's an opportunity to split these things up. A little bit. Really highlight chiropractic adjustments, really highlight individually osteopathic manipulation, massage and then over time see how those modalities can impact gait patterns in specific populations of individuals. So great study. Hopefully some take home messages there for you. Maybe a little inspiration to check those gait patterns. I know sometimes we are taught that in school and might sleep on it a little bit in terms of practice. But keep an eye on gait. You can watch people when they're coming down the hall, watch them when they're ready to get on the table, see how they are moving because that might give you a real insight into how you can help them improve their quality of life. Not only today but tomorrow. Now before we wrap up, if you are into objective assessments, you have to check out neckcare.com Reliable assessments and exercises for neuromuscular control, proprioception, range of motion, sensory motor integration. Some of the best technology I have seen coming into the chiropractic space in a long time. Neckcare.com will drop that link down below and I will wrap up by saying if you are thinking about bringing shockwave therapy into your practice, check out stemwave. It is literally what I use in the practice that I own. Go stemwave.com the evidence based chiropractor. Connect with them there. They'll hook you up with their best deal. They support this podcast. I'll ask you to support them. They're I will drop that link also down in the show notes and if you have not left a rating or review, if you take a moment and do so for this podcast that helps us reach more people and I would greatly appreciate it. Otherwise, I hope you have a fantastic week in practice and I will talk to you soon.

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Sam.