451- How Spinal Adjustments Impact Brain Metabolites in Chronic Low Back Pain Patients

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. On Today's Episode we are back with another brand new study that is all around brain changes after spinal adjustments, some clinical pearls, take home messages and a lot to dive into on today's episode. Before we get started, I want to say a few words about Jane App. Today's episode is sponsored by Jane, My favorite emr. The Jane team knows that when your workday is spent providing care to your patients, it can feel like there aren't enough hours in the day for the rest of your admin tasks. And that is where they pick things up and go from there. User friendly online booking, great interface, awesome support team. It is all there for you at Jane and as a listener to this podcast they'll hook you up with a one month grace period using the code EBC1MO. I'll drop a link down in the show notes if you have not been 100% satisfied with your current EHR EMR talk with the Jane team. But as I said at the top of today's episode, it is all about research. Title of the Study the application of spinal manipulation results in alterations in thalamic neural metabolite among patients experiencing non specific chronic low back pain. And this is a good one. Chances are if you've been in practice more than a moment, you have seen a couple patients with non specific chronic low back pain. It's one of the most popular things we see in practice all day, every day. And the question is, I think has been answered to a certain degree. Yet there is still so much more to uncover in terms of how exactly does it work? Meaning when somebody receives a spinal adjustment in your practice, they walk out happier, healthier, moving, better, feeling better, functionally improved. How's that work? And today's study starts to highlight some of the answers to that question. So we know pain is the most common symptom for anything spinal related, and low back pain is actually the leading cause of functional limitation in individuals younger than 50. We often think about people that are older, maybe with spinal stenosis, but it is the leading cause of functional limitation under the age of 50. And we also know that the etiology and the source of non specific chronic low back pain is is not exactly pinpointed, so to speak. And a Lot of this comes from 30% roughly of acute pain will transition to chronic, which is why it is so important to get the right care early on and why movement based care, such as what we do is so important early on in the process so that acute does not become chronic. But for those that do struggle with chronic pain, still what we provide, it can be a very, very, very important part of their healing journey. So brain imaging and or metabolic studies have been used to actually assess objective pain measurements and it is all about scanning the brain. So we've all heard of functional MRI, but today we're going to talk about Mrs. Mrs. Is a single voxel proton magnetic resonance spectroscopy. That's a mouthful right there. I'm gonna call it mrs, but it is a complement to a functional mri. And functional MRI studies have been conducted on patients with chronic pain and they could really indicate functional and morphological changes in the brain. And with patients that have non specific chronic low back pain, they can actually exhibit a decrease in neurochemical metabolites in the thalamus. And that's really going to be what we are going to focus on today. Studies have shown that chiropractic adjustments, spinal manipulations can lead to improved function and reduced pain, of course in those patients that are struggling with chronic low back pain. And the thought is that the neurochemical changes might play a really, really important, a critical role in pain perception and its treatment. So mrs, as we discussed earlier, long, long name there, but it is a non invasive examination and it assesses specifically, here's why it's being used in the study. It specifically assesses neurometabolites. There's a variety of them. We'll dive into some of them as this study moves on. But this is what we're gonna be measuring today, or the researchers measured moons ago, I should say. So this study conducted those Mrs. Studies on the thalamus before and after patients received a chiropractic adjustment. All of the patients had chronic low back pain, nonspecific. And this was compared to healthy controls to try to extrapolate and say what are the differences in the metabolic spectrum of patients that are healthy, patients that are dealing with nonspecific chronic low back pain and those that have chronic nonspecific low back pain, but that are taken care of by a chiropractor, receive at least one spinal adjustment. And that was really the point of this study. So they measured it at baseline and five weeks after the intervention. And there was a variety of data points collected including functional disability, pain and of Course, all of those brain neurometabolites were documented and analyzed, and the findings are really, really impressive. The findings should be really exciting to you as a listener because they highlight the impact that a spinal adjustment can make. And five weeks after the spinal adjustment, the treatment group, which is those that received the care, displayed significant differences in NRS and ODI compared with baseline. So they were. They had functional improvement and they also had significant pain reduction. We've seen this play out time and time again, but in my mind, this is one of those things where it's like the hit. It never gets old. You're just gonna want to keep listening to it. This is that every time we see in a great research study the fact that NRS scores, pain scores, ODI scores, disability scores are being impacted and improved by the hallmark of what we do. That's an exciting day. And it just continues to stack and add to that expansive, ever increasing body of literature highlighting and supporting what we do. And for patients with, I'm going to say specifically in this case, we're talking about patients that have nonspecific chronic low back pain. This is a big deal. These patients are functionally limited. They're in pain. And as we know, the longer you're in chronic pain, the more difficult it is to come out. There's a psychological component, there's physiological components, there's biomechanical components, and these items start to stack upon themselves. Of course, those individuals that have chronic low back pain, they're also the most likely in many cases to seek advanced interventions. Whether that is advanced imaging that leads to injections, esis, we've talked about that extensively on here, or whether it leads to elective surgeries. And many of these items don't perform very well, quite frankly, in terms of the literature. And they have massive trade offs, whether it's biomechanically, whether it's structurally, whether it is side effects, whether it's risk. All of these have massive, massive increases in risk. Compared to receiving a spinal adjustment at the SI joint at L5S, one of the lumbar sacral spine. That's really important to keep in mind because when we look at studies where we see pain decreased and disability decreased or functional ability increased, sometimes that can seem almost old hat, like, wow, okay, but. But it's a big deal. And it's a really big deal as we see this across a plethora of studies that are really analyzing different things, but always come with that conclusion. I love it. I hope you love it as well. I just wanted to give It a little bit of a side. So brain metabolites at baseline of the treatment group were noticeably lower than those of the controlled healthy subjects. But at five weeks post treatment, no significant differences were observed between the treatment and control subjects. That is powerful within the treatment group. Some of those metabolites, naa, cho, glx, mio, showed substantial increases in the thalamus region five weeks after the patient received a spinal adjustment compared to baseline. And we're gonna dive into some of the specifics of that wording momentarily. So the results of this study ultimately highlighted that for patients that are struggling with chronic low back pain, five weeks after a lumbosacral adjustment, disability and pain were significantly and clinically love to see those words. Significant means exactly what it says. Clinically means exactly what it says together. That's really nice when there's clinical significance. And it is a significant reduction statistically. Moreover, five weeks after spinal manipulation for the treatment group, a significant increase of metabolite concentrations were found in the thalamus, which was similar to healthy subjects at that time. Now, there have been other studies that showcase how a chiropractic adjustment is an effective non invasive treatment for individuals with chronic low back pain. And you can see reduction in pain and improved function for a period ranging from three to six months following the care that is also super impactful. And that is not something to sleep on, even though it goes by quick in the study, which is the care you deliver today can really have meaningful impact three, six months down the road. In this case, it was an adjustment was given and five weeks later they're measuring things and there's big differences. So it's not only the immediate impact. Yes, somebody gets up off your table, they're moving a little better, they feel better, they got a little bit of move, you know, jumping their step, walking out that front door. But. But it's also imperative to understand that for many people, that improvement is going to either continue or sustain for months after that care that is super powerful. Now, the neurophysiological mechanism of an adjustment is attributed to a variety of things. But the central nervous system's ability to modulate sensory information is something that keeps coming back. We know there are sensory receptors around the facet, joints, vertebra, spine, in general. They're all activated by an adjustment and affect the transmission of afferent input and motor function from that spinal cord to the cerebral cortex. We also know that an adjustment can stimulate type 1 and type 2 receptors, Golgi tendon organs, and affect central nervous system processing of sensory input. So improved function, reduced pain following adjustment were attributed to these processes in the central nervous system. So you're not only impacting that joint, you're really impacting the entire central nervous system. This study showed that following lumbosacral and adjustment metabolites were significantly elevated in the thalamus compared to baseline measures. That is a good thing. So their conclusion was quote. In patients presenting with nonspecific chronic low back pain, spinal manipulation has been observed to provide pain relief with corresponding effects in the thalamic metabolite. Great study. Lot there to kind of unpack. And I think future studies will unpack every little nook and cranny, every segment of what was highlighted today. But this is a really cool study. It highlights a couple things for me that I'll sort of recap as we come towards a conclusion. One is that we impact the central nervous system in a meaningful way. And specifically, we can impact thalamic metabolites in the brain based upon what we do. Two, it's not just then, but it's weeks and months down the road that those effects can either continue or, or improve. That is powerful. Three, we see yet again that pain and disability can be improved upon when somebody receives a adjustment that is powerful. And don't forget, in this study, that was a single adjustment. Imagine what happens when you string together some care. We all know that pain is the last thing to come and the first thing to go. And that is why it's so important. Regardless of the range of motion, the movement assessment that you choose to use, understanding the habits that these individuals have formed, and again, especially with chronic low back pain, do not forget about the compensatory measures people go through. People that have been living in pain often come into your practice. How long have you been Living with this? 5 years? 10 years? 15 years? As we all know, it's the life effect that drives somebody into your practice, not the pain. People will live with pain forever. It's when they couldn't go to Disney, when they couldn't do this, when they're concerned about their job, Whatever it is for them, that life effect is ultimately what drove them in. Most people most of the time will deal with pain and hope it's going to go away for exceedingly long periods of time. So anytime somebody comes in and they've been living with pain months or years, you can expect compensation to take place. So when we look at a study like this, this is a single adjustment given with massive impact. But it's important to remember for individuals that have had chronic low back pain, there very likely has been compensation. There very likely has been biomechanical changes. There's been pattern changes literally in how they move and how their brain interprets that movement. So speaking into that, highlighting a care plan that really helps people not only get out of pain, that should happen very quickly and very easily in most cases, but helping them find long term functional improvement and absolutely critical. And part of that's understanding their motivations, part of that is understanding what they hope to do and where they're at today. So great study, lot to dive into. I hope you enjoyed it. Before we wrap up, if you geek out on this kind of stuff and you love objective assessments, you gotta check out neckcare. It is the best objective assessment tool for the cervical spine I have ever seen. Neuromusculoskeletal control, proprioception, range of motion, sensory motor integration. It's all there and more. You can check out the YouTube videos I've shot. You can also just head over and have a conversation with them. Neckcare.com, easy to remember. Neckcare.com, i'll drop a link down in the show notes. And finally, Patient Pilot if you're looking to grow your patient reactivations this year, it is the easiest place to generate revenue. I can tell you that we have just made a massive upgrade with Patient Navigator that gives you a Smart Patient Recall list. All of the information we get from Campaign Autopilot, which are the weekly email that go out, we measure that engagement, we lead, score your inactive patients and then serve them up to you on a silver platter in Patient Navigator via the Smart Patient Recall List so you can see exactly who is most likely to reactivate so you can reach out to them and have that communication that is ultimate patient experience. That's what's going on. Check it out. Thesmartchiropractor.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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