501- Exploring Immediate Anatomical Changes From 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. This week we are back with more research and this is all about what happens when a spinal adjustment is delivered. We're gonna take a look at the anatomy and this is a really cool study that reviewed nearly 20,000 articles and narrowed it down to 20. And there are some key takeaways we're gonna dive into. Additionally some question marks as well in terms of where research might go in the future. Now, before we get started, I want to say a few words about Leander Tables. You've heard me say it before, you'll hear me say it again. They will hook you up with $1,000 off their Series 950 Flexion distraction table. As a listener of this podcast, you can use the code EBC 2025, visit the page down in the show notes or just chat with their team and let them know you are a listener and they will hook you up with a big discount. A table is one of the most valuable investments you can make into your practice and Leander makes some of the best out there. Now, before we get any farther, I want to make sure that you're also aware of NET Care, the best objective assessment tool out there as well netcare do reliable assessments and exercises for neuromuscular control, proprioception, range of motion, sensory motor integration. If you let them know you are a listener here, you will receive them first month for free just for listening to this podcast, hooking you up with thousands of dollars of benefits. Now, today's podcast is all about the research. So we're gonna dive into a study, a new study that if you've ever wondered what really goes on under the surface, so to speak, after you deliver a high velocity low amplitude adjustment, you are going to want to stick around. We know spinal manipulation been around over 125 years, known as chiropractic, probably we estimate many thousands of years before that adjustments were performed. But chiropractic adjustments started a little bit over 125 years ago and has proven itself to be one of the most safe and effective conservative clinical techniques, tools, professions for neuromusculoskeletal care. And as we continue to learn more, also for human performance. We see it all day, every day in our practices as people come in and they leave, they're feeling better, they're moving better, and they keep coming back. But the question often is, why? How does this happen? So there's a study in chiropractic and manual therapies that tackled a simple but surprisingly unanswered question. That question is, do spinal adjustments lead to immediate, immediate anatomical or positional changes in the body? Again, they reviewed over 20,000 articles and narrowed it down to just 20 studies, of which eight were considered to be of the highest caliber. So they were credible based upon the risk of bias and methodological rigor, all of those things. They narrowed it down. Now, a couple things to keep in mind as we start to go through this study. Remember, they talked about immediate anatomical or positional changes. So we've highlighted the mechanisms of action go far beyond anatomical or positional changes when you deliver an adjustment. There are impacts to the peripheral nervous system, impacts to the central nervous system. There are brain changes that occur. There is afferent and efferent influence, so to speak. So there are a host of positive benefits when you deliver an adjustment that go far beyond the anatomical or positional changes. But anatomical positional changes can be important as well. So they did find that facet joint spaces increase. There were four high quality studies that showcased lumbar facet joint space increase increased after a spinal adjustment. Now, important to keep in mind that these increases in space became variable when somebody got up and moved around. So it's not just the fact that there's space in the facet that's the benefit is where I'm going with this. It's the fact that the facet not only has space that tells us that any adhesions probably have been diminished or eliminated. And then secondarily, we're looking for improved facet glide. So that gapping of the facet. There's a few things that happen. One is that there are small neurovascular bundles that occur in the facet joints, especially as we get older. So being able to gap that facet, even temporarily, can sort of act. I'm going to oversimplify it, but almost as a reset to that facet joint in terms of again, afferent inferior input, in terms of being able to decrease pain and improve functional movement, that gap is really, really important. Another finding was a study that reported spinal stiffness decreases, a clear and immediate reduction in spinal stiffness after an adjustment. So the spine was measurably less stiff immediately after care. And they had a quote here quote, reduced spinal stiffness post spinal manipulation was a consistent finding. In credible articles. Now, why does spinal stiffness matter? Well, this goes far beyond what I'm gonna touch on today, but I'll highlight a few key things. One, spinal stiffness is a research measure that's used quite often, and stiffness tends to be negative. So, you know, we always say the balance of, we want the balance of strength and flexibility. Stiffness is an antagonist against that strength and flexibility. So stiffness is not something we want. We want strength and flexibility. Flexibility doesn't mean hypermobility because you want to have that balanced with strength. Of course. So when we see reduced spinal stiffness, there are many studies out there that have highlighted a reduced spinal stiffness can lead to a reduced risk of injury. You probably see where I'm going with this now. So when you're reducing spinal stiffness, this is a reduction in injury potential long term for a variety of different injury types. So this is massively impactful. Not only, yeah, moving a little bit better sounds good, but this actually is a long term benefit for people when there's reduced stiffness. So what does this mean for your practice? It means that there are measurable anatomical changes happening, especially when we discuss the joint positioning and spinal stiffness. And this correlates probably with what you see all day, every day. Now, there are classic theories like, you know, vertebral repositioning, like, you know, that our bodies are dynamic. Right. So sometimes that can fall away under scrutiny. But this evidence does support biomechanical effects, particularly at that facet joint level. So when you think about how somebody is moving, understanding as you're going through, whether it's Kemp's test, whether it's motion palpation, whether it's a movement assessment, whatever it might be. Analyzing facet joint movement, really, really important because of course, when you deliver your adjustment in the facet joint, the goal is to help that face set move better and then the spinal stiffness as well. Are you going through, and the question is, are you going through any movement assessments pre and or post adjustment, at your re evals, whenever it might be in your practice that start to give you clues to spinal stiffness? We're not all able to in a research setting, they'll typically have a patient laying prone or seated. They'll use sort of almost think of it like something that looks like an activator, but it's actually measuring the stiffness of the muscle. That's highly research based. Right. That's not really clinically implementable. So what are you doing in your clinic that can start to clue you in to spinal stiffness and I think very clearly and quickly of movement assessments that you can implement. So additionally, ensuring that people understand this and they don't need to understand every single nuanced detail, but, but understanding that not only is the care that you deliver helping them feel better, it's helping them move better. And that the choices they make when they leave your practice, whether they do their exercises or not, how they're sitting posturally at the computer, whether they're taking breaks, all contribute to that ability to have better balance of strength and flexibility. These are also great research studies, so to speak, to highlight if you're speaking with other healthcare providers that really want to geek out on the specifics, that want to understand, well, how is this really working at that spinal segment level and being able to discuss. Well, there's two things we know that are happening unequivocally when we talk about anatomical positioning. One, we see a decrease in spinal stiffness. Two is that we see improvement gapping of the facet joint that leads to improved motion. That's a really quick, quick and easy way to describe what the study findings were in a way that another healthcare provider is gonna pick up on and understand immediately. And, and again, then you get to dive in, then you have the awesome opportunity to dive into all of those other things. We also see, you know, influence on the afferent and efferent input. We see decreases in pain, we see biochemical marker changes in the brain. We see cortical drive being temporarily improved in the lower extreme. I mean, there is a lot that you can dive into neurologically after you touch on just the simple basics of what's going on biomechanically. And to me, that's where this research study, it doesn't tell the whole story. It, it doesn't go into the neurological components at all. But what it does is gives us a really, really nice foundation from a biomechanical perspective to say, hey, with thousands of studies analyzed, we've cherry picked the best. Not based upon what we wanted to see, but based upon the quality of the evidence. And what we found was facet joints gap and move better. What we found was spinal stiffness decreases. And when you say that to a pt, an md, a, do an np, a pa, you name the credentials. And that's meaningful stuff because many of them understand how that impacts not only the patient's pain and function that day, but again, reducing that risk of likelihood of injury as time goes on. And again, if a patient asks, hey, what is this doing what does an adjustment do? This is an easy way to describe the biomechanics really, really quickly. Now, as chiropractors, we operate on the front lines of musculoskeletal care, and I'm gonna say on the front lines of neuromusculoskeletal care, so. So it's super validating. Anytime I see systematic reviews like this, reaffirming what we see and feel in our hands each and every day that spinal adjustments do something biomechanically. When we look at the front end of our patients from a biopsychosocial model, when we look at the back end of our care delivery with a neurological and a biomechanical lens, we start to see the real magic of what we can provide, what we do provide, and what we can continue to provide people in our communities. So understanding and communicating why something works is a great way to build trust, to build confidence, to get more referrals, to do all of those things you need to do to build and grow your business. So here are a few quotes from this study. One quote was, we found a few studies on this topic. However, there were two promising areas for future study research, facet joint space and spinal stiffness. So I have a feeling that facet joint space gapping is not going away in the research anytime soon. I have a feeling that spinal stiffness is not going away as a criteria anytime soon. And that should be really great news for you and I because what we do has a direct impact on that. So as you're taking care of individuals with lumbar herniations, as you are taking care of individuals with cervical genetic headaches, as you are taking care of individuals with nonspecific low back pain, it's important keep this stuff in mind, think about it, communicate it, and utilize it for the benefit of your patients. Whether that's the communication you're having in your practice or whether that's the communication that's going on across all of your channels, whether it be social media, website, et cetera. So I'm gonna drop a link down to this study in the show notes. You can check it out and just again, a huge thank you for tuning in and listening to this podcast, whether it's your first episode or whether you've been with us for over 500 episodes, thank you so much for taking a moment and tuning in. If you have any research you would like to see highlighted in future episodes, you can always email me Jeff, the evidencebasedchiropractor.com Other than that, I want to say thank you so much for tuning in. Thank you for being a chiropractor. Have a fantastic week in practice and I will talk to you soon.

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