486- Why Manual Therapy Matters Beyond Biomechanics

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'm your host, Dr. Jeff Langmaid. On today's episode, we are back with more brand new research and again, I will say it is a good one. We're going to talk about the science behind why and how manual therapy works. Great study. Before we get started, I want to say a few words about Patient Pilot. If you have a patient list and there are inactive patients on that patient list and you're not communicating with that patient list weekly, you are leaving the opportunity to generate revenue and help more people on the table. Your patient list is the most valuable asset you have in your business. All of those people know, like and trust you. So if you believe you are a pretty good chiropractor and you believe a good amount of those people would come back and see you and you're not doing anything about it, we can solve that issue. Visit thesmartchiropractor.com check out patient pilot, which automates the entire patient reactivation process. And we have a special offer going on right now. You can check that all out@the smartchiropractor.com but as I said at the top, we're talking research today. The title of this one, we'll drop it in the show. Notes, of course. The mechanisms of manual therapy. A living review of systematic narrative and scoping reviews. So you've probably heard the claims that manual therapy, whether it's spinal adjustments, mobilization or soft tissue work, just helps people through biomechanical changes. But is that the truth? And this study really unveils the real mechanisms, which are far more complex, way more interesting and way more powerful than simply biomechanical change. Again, this is a brand new study, came out 2025, literally just a few weeks ago. And it's what's called a living review. It was published in PLOS ONE and pulls together 62 systematic, narrative and scoping reviews to map out the physiological, neurological, biochemical responses that are triggered through manual therapy. And this is literally one of the most comprehensive reviews ever done. And it gives us, as chiropractors, the science to back up what we do each and every day. And if that sounds exciting to you, you're gonna love this episode. So let's start with the basics. Why does this study matter? Well, manual therapy, widely used of course by us as chiropractors, physical therapists, osteopaths and massage therapists. And up until now, studies exploring how manual therapy works have been scattered across a ton of different disciplines, different professions, different patient types, basically just super siloed. And this is basically a review of the reviews. So it pulls all of that data together and creates again what they call a living digital resource, which is actually hosted by Duke University's center for Excellence in Manual and Manipulative Therapy. And remember, this is really important, these planting of the flags as I like to think of it. This study is not saying, does manual therapy work? Not even close. It's assuming that it does, which we know it does throughout decades of literature and asks the more important question, the more nuanced question, the more powerful question, how does it work? So the big idea here is that manual therapy triggers a ridiculous cascade of complex and multi system responses. So you know, we can forget that old school view that manual therapy just moves stuff around or it just stretches tight muscles. It's so far beyond that. And this study highlights that manual therapy triggers multi system physiological responses and including, I'd say get your pen and paper out, but this is a pretty long list. These are all of what they found. It includes neurological mechanisms, spinal and brain based effects like altered MRI activity. We've highlighted those studies on this podcast. Neuroimmune responses, changes in inflammatory cytokines and immune markers, neuroendocrine responses, cortisol release, stress regulation, neurovascular effects, changes in blood flow and autonomic nervous system activity, neurotransmitter release, including serotonin, dopamine, beta endorphins, neuromuscular activation, improved coordination, recruitment, muscle tone and of course those biomechanical effects, spinal motion, disc hydration, joint space and fluid dynamics. That is a lot of information that I just went through now, much of it you might be saying, okay, I've heard that before, I've followed along, but I want you to take a moment and step back. It's all of those things through the care you deliver. Neurological, neuroimmune, neuroendocrine, neurovascular, neurotransmitter release, neuromuscular, biomechanical, all of those things are occurring. And you've probably heard me say this before, if you've been following the show, which is the breadth and depth of what we do through the mechanism of action in a spinal adjustment or manual therapy. It's almost difficult because it's so wide. It's difficult to study. That is because it's so wide. And sometimes that can also create the challenge. And we'll talk about this later in the episode where it's difficult to explain because there's just a lot going on. So where do you pick and choose what you're gonna talk about with the patient? How do you put it into any language at all that they could possibly understand? And then I'll go really crazy. And that they could communicate to another human being themselves without you being there? Right. All of those things are challenges for us as a chiropractic profession. Those are the primary, in my opinion, one of the primary reason, I'll just call it what it is. Our communication is the primary reason we're stuck at 15% or less of utilization. It's not because people don't like the experience. We have literally the highest patient satisfaction amongst nearly every healthcare provider. What we have is a communication issue. How is that reflected? That's reflected in decreased trust. It's like the have and the have nots. People who go to see a chiropractor generally love the experience. Super high patient satisfaction. Those who don't typically never do and believe it all to be charlatan activity. And that's wild. But what that tells us is that there's a dramatic communication issue. If the message isn't getting through. People are dramatically skeptical. Now, some of that's probably self inflicted wounds. Us using nomenclature that's not standardized is a challenge to that. And that was necessary back in the day for a whole host of reasons beyond this episode. Reasons in law, reasons when the AMA was coming after chiropractic. A whole host of reasons. However, now we have the research and it's been cooking for 30, 40 years here. Highlighting who you are. I was gonna say who we are, who you are and what you do. And it's our responsibility to understand the information and to be able to communicate the information in a way that people can understand. And that's really the clincher because often I'm going to tell you, you probably talk at a level that's above the patient's coming in. And when the patient is unable to take one, you can't expect a patient to take three steps of knowledge. It's one step at a time. So this is the balancing act. This is the art of communication. How do you simplify things down in a way where somebody doesn't need to study four years to understand it while not changing the meaning? That's the real challenge. And that's something that all of us need to improve and hopefully by listening to this podcast, you get some refinement of that over time. But that is really a key aspect of our profession's success, or lack thereof. And I'll go very individualized. It's a key aspect of your success or not. How effectively are you communicating who you are and what you do? So what, what does this study mean for clinical practice? Well, we can start by saying manual therapy affects the brain and the body, not just the spine. It can influence things like pain, perception, inflammation regulation, autonomic balance, and neuroplasticity. How exciting is that? And the context matters. Patient expectations, communication, treatment, environment all play roles in the effectiveness of manual therapy, as it does with everything. And it's not just about the thrust. Effects are seen across mobilization, manipulation, and even some soft tissue therapy. And all forms of manual therapy have been shown to produce some amount of measurable changes. And there's no single mechanism that explains all the benefits. This is a converging effect of multiple systems that's really, I'm gonna say, customized by patient presentation. How will what you do affects who, who you are treating? Well, that depends upon what you're doing, and it depends upon who they are. And I don't mean that in terms of literally what their name is, but in terms of their body. What are they dealing with? Are they asymptomatic, are they symptomatic? Are they symptomatic due to a nerve compression or due to a chemical exposure, so to speak? All of those things are going to impact how the manual therapy you deliver results in the benefit for the patient. And that's important to keep in mind. And there's just some massive big takeaways, I think, for you, for me, for everybody listening to use this research to elevate your care and your confidence. And some of this goes, I'm gonna say, into the realm of reframing your patient. Communication, it's not just about moving things. When you deliver an adjustment, this is about helping your brain and nervous system process pain more effectively. In manual therapy, what we do here can help you regulate inflammation, improve your mobility, and calm your stress response. Those are relatively simple statements that you probably haven't said that simplistically. Again, the adjustment I'm gonna deliver today can help your brain and nervous system process pain more effectively. For many people, that results in a reduction in pain. But it's important to remember pain is the last thing to come and the first thing to go. And we wanna make sure you're set up for success for the long term, to not Just today and tomorrow, Very simple statement, but you have to put it into terms that people can understand. Manual therapy, again, what we do here can help you regulate inflammation and improve mobility while reducing stress on your body and nervous system. That's a simple statement, but it's powerful. You don't need to over explain, but you don't need to under explain. The second thing is individualized treatment. Again, takeaways for all of us here. Not every patient needs the same force, the same frequency or technique. I think we do a really good job of this as chiropractor. So thinking about the care you deliver is my aim. Pain modulation is my aim. Inflammation reduction is my aim. Autonomic regulation, now it's not exactly A plus B equals C yet. And that's a great thing. It enables you to choose the technique. But be mindful of that. I think often we can get into maybe ruts as providers where we're delivering some of the same care and treatment because we all have the things that we love, we all have the things that we know works, we all have our go to, our go to adjustment. But, but think about it, what are you trying to affect in terms of change and maybe even think back to some of your previous patients based upon what you've done, what's been the response in them? That's a great learning opportunity for you to continue to refine your care. That doesn't require an adjusting technique seminar. It just requires you to kind of tune in to the care and treatment that you're delivering. Additionally important to embrace the biopsychosocial model. This study reinforces that manual therapy is both physical and neurological. It's contextual and relational and that's important to remember. There's a lot of things going on when somebody comes in beyond pain. Pain is the least of their reasons that they came in. They came in because of the life impact and life effect. What they can't do as a result of that pain, they're also coming in with fear. They're also coming in with baggage. Good or bad, previous chiropractic experience, they're also coming in with baggage. Have they told their spouse, their kid, somebody at work that they're going to see a chiropractor and did they receive a response that that's awesome, they're gonna be able to help you and man, that's the best thing you can do? Or are they getting side eyed or why don't you go see my orthopedic? They're a real doctor and I'm just gonna Call it as it is. Our market penetration is 15%. The odds are not in our favor that that conversation is going to be the one we'd want. So how do you take that conversation and reframe it in your practice? That's your opportunity. And I'll do a plug for patient pilot beyond the four walls of your practice. If you're not communicating with your patients beyond the four walls of your practice be or maybe just some social posts you're messing up. You know, to not communicate with your patients through email each and every week and guide them on a journey to better health for a couple hundred bucks a month is just lunacy. If you're trying to build a successful business and if your heart is in the place of taking care of people, I'll just call it what it is. So that's a, that's a key component. So let's get back to the study. I think clinical wisdom one, manual therapy has effects from far beyond the biomechanics of the joint. Adjustments are likely to work because of their ability to do multiple things. Modulate pain, promote healing through both neuroplasticity and systemic regulation. And we're in need of some more translational studies for like how do we figure out what to do and what impact? And it's never gonna be perfect. And that's great and it's not trying to put you in a box. But it'd be interesting to learn more about this and be able to clarify the mechanisms by which manual therapy works. The more clear we can become, the more specific we can be and the happier everybod. So I view this study as a big gift to our profession and it should give you the confidence to say we're helping people in ways science is just beginning to fully understand. That's a powerful statement because many. Oh, chiropractic is not scientific. There's no research. No, we're helping people in a way that science is just beginning to understand. We're ahead of the curve. We're not off the curve. Second, there's more to the adjustment than just movement. There's modulation. That's an important statement. And chiropractors aren't just spine doctors. We're nervous system and pain science specialists love that one. And performance as well. And performance as well. So again, I'm gonna drop a link down to the study in the show notes. You can check it out. If you've been listening and you haven't left a rating or review and you take a moment and do so, I would greatly, greatly appreciate it that helps More Docs Find out about this podcast so if you're on Spotify, if you're on Apple podcast, just tap how many stars leave a review. That'd be awesome. And before we wrap up, I wanna say a few words about TurnCloud, TurnCloud EHR that has stripped away everything that is not essential and made everyday functions simpler. They've created an intuitive application where no one needs a user manual. How nice does that connect with their team? Turncloud.com, schedule a demo, hop on, see if it's right for you. That's a few minutes of your time that could save you hundreds of hours and thousands of dollars if it's the right solution. And the only way to know is to connect with your team. Turncloud.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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