524- How Spinal Manipulation Impacts the Nervous System in Chronic Musculoskeletal Pain

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. Happy New Year and welcome back. Whether this is your first episode listening or you've tuned in for 10 years plus, thanks for taking time out of your day to listen in to this podcast. This week we are kicking off the year with another brand new research study. This one's all around chronic pain. It's titled the Pathophysiologic Mechanisms of Spinal Manipulative Therapy and in the Management of Chronic Musculoskeletal Pain. We're gonna dive into what this brand new research says, how it's applicable in your practice, what the researchers found, and much more. Before we get started, big shout out to Leander Tables, a partner and sponsor of this podcast. They're gonna hook you up with $1,000 off their Series 950 table. You can use the code EBC2025 or visit their website to to learn more as well as Bluehonest lasers. Full spectrum lasers. I had a doc email me. He picked one up and he is pumped. He loves the quality of the laser and they're Gonna give you $2,500 off their Pro VX laser when I drop a link down in the show notes so you can check that out. But the research today is all about chronic pain. Again, pathophysiologic mechanisms of how SMT works in the management of chronic musculoskeletal pain. So if you're listening to this ch, are you take care of a lot of people with chronic musculoskeletal pain and chances are you're delivering adjustments to them each and every day in your practice. So this study tries to answer the question of how does this all work? And we can actually pick this up with a question that I know everybody listening has heard at least once this week, maybe once this month. And that' sthis is how story starts. You adjust them, they feel great. The patient comes back a few days later and says, I don't get it, doc. The pain's back and it hurts even a little bit more. And in that moment, that often can be a challenging statement like, what do you say to that? Because you know that their joints are moving better, you know that the tissue underhand for you feels better. And you also know that the imaging might not explain the intensity of the pain, yet the patient. They're not wrong when they're telling you this. So today's episode is really about why that situation happens, why chronic pain, pain doesn't behave like acute pain, and most importantly, how the adjustments you deliver fit into the modern neuroscience of chronic musculoskeletal pain. And this comes down to two key words that you've heard before in this podcast. You're probably going to hear a lot more as we continue on, and that's central sensitization, and that is we're going to discuss why that matters and how this research gives you, as a chiropractor, one of the strongest and most defined explanations for what we do, and so that you can explain it the right way. So this podcast, 2025 narrative review published in the Journal of the Canadian Chiropractic Association. And instead of asking, I'm going to say the simple question of do adjustments work? Which is kind of tired at this point in time, this paper goes one step farther, something far more interesting. The question that they're asking is how do spinal adjustments influence the nervous system, specifically with people that are struggling with chronic musculoskeletal pain? And the authors focus on one major driver of chronic pain, that is central sensitization, which in plain English means this. The nervous system has become too good at producing pain, not because the tissue is still damaged, but because the pain system itself has adapted. And. And that adaption has not been in a good way. And the reason this matters so much for us as chiropractors is because chronic musculoskeletal pain, low back pain, neck pain, osteoarthritis, myofascial pain is literally what walks through your door each and every day. So this paper reframes chiropractic care inside of a neurophysiological model. Not necessarily a bone being out of place or a purely mechanical one, but inside of a neurophysiologic model, which I think is exactly who we are and what we do as we've continued to see the science evolve. So I like this study because it touches on real world stuff. People with chronic musculoskeletal pain, how is their body reacting, and how does the adjustment you deliver influence how they perceive pain? And there's a big difference. We're going to dive into it in a moment, but it's just such a big, big difference between acute and chronic pain. Acute is the healing process. Chronicity is a problem. And that's really where early intervention matters. Tying back to studies that We've talked about over the last Q4 of 20, 25, early interventions. Did they see you first or did they eat up the first three months of pain? Chomping through pills at a primary care doctor and then coming in to see you where now acute pain has become chronic. The pills didn't work because there was a structural issue. You, you know, the kit and caboodle, you know, the whole story there. But it's important to highlight that because the research like this, it's not opaque, it's not this separate thing from what you do. It's actually a direct explanation about what you do and about whom you deliver care to. And that's really, really critical as we bridge the research into practical application. So in this study, let's start by hitting on a few highlights that really matter clinically. First, chronic pain is exploding, and that's not a great thing. Chronic musculoskeletal pain is one of the leading causes of disability worldwide. And In Canada alone, one in five adults, 20% of the population, live with chronic pain. About 50% of them had pain more than 10 years. So this is a real big challenge. The economic burden for that, oh, just a cool $40 billion. So this isn't like some hyper niche issue. This is like the issue. And the same thing in Canada holds true in the United States. If you're listening over, you know, in, in Asia, if you're listening in, you know, anywhere in Europe, a lot of these same stats carry through. Chronic musculoskeletal pain is a big issue, costing a lot of money, impacting not only those individuals, but you have to remember it not only in, not only, so to speak, cost the individual in pain, it costs their family. And cost is not always about dollars. It's about mental opportunity. It's about taking care of people. It's about the inability to enjoy life to its fullest. And that's a massive, massive issue. So the second key highlight here is that central sensitization changes the rules. So this paper explains that chronic pain often persists even after the tissue healing and has either started or is in progress. Because spinal cord neurons become hyper excitable, pain signals can then get amplified. Non painful input can feel painful or become painful. And pain spreads beyond the original injury site. So clinically this shows up as things you see all the time. Pain that doesn't match the imaging. Ever seen that before? Pain that feels unpredictable? Probably saw that today. You know, pain that flares up without clear mechanical triggers and heightened sensitivity to pressure, to movement, to touch. You Know these individuals, they lay down on their table, you haven't even put your hands on them yet, and they're jumping off the table. You touch them and they are oof, ah, you know, and it doesn't mean that they're lying. It means that their body has really adapted in a, in a manner that is sub optimal, to say the least. So third key highlight as we continue to go through is that the adjustments you deliver affect more than the joints alone. You probably know that, right? Adjust influence pain through neurophysiologic modulation, not only biomechanics. So literature shows that adjustments can do a few important things. These are key points here. Reduce dorsal horn neuron excitability, they can influence temporal summation, they can improve pain pressure thresholds, they can affect sympathetic nervous system activity, and they can influence super supraspinal centers involved in pain processing. There's a lot of alliteration in these words, but it can do all of that and then some. So in other words, adjustments don't only move joints. It is really speaking to influencing, connecting directly with the nervous system. So let's make this practical. So what is central sensitization really? Well, central sensitization starts as a normal protective process, but when the pain sticks around too long, AKA chronic receptors can get activated, calcium can flood into the neuron and pain pathways can become trained, and that's the key word here, they become trained to fire faster and stronger. So it's like the volume knob on. Pain gets turned up, but then it gets stuck there. And that's why light pressure hurts, movement hurts, stress worsens the symptoms, pain spreads. And this explains why chronic pain can often seem really disproportionate. So there's a neurogenic inflammation piece as well. And this is one of the most fascinating sections of the paper, when they dive into neurogenic inflammation. So instead of inflammation being driven only by the tissue injury, which would make sense, well, the nervous system itself can release inflammatory neuropeptides like substance P, cgrp, which then sensitize tissues, increase pain and maintain chronic inflammation even without a new injury. So this gives a biological explanation to myofascial pain, to viscerosomatic pain patterns, and to pain that does not have a clear structural input. So this is really what opens the door for the adjustments that you deliver. Adjustments can actually stimulate mechanoreceptors, which you're probably aware of. Well, what does that do? Well, it competes with that pain input. It also can induce inhibitory spinal cord effects, it can reduce hyperexcitability it can reset motor neuron activity and it can influence descending pain modulation. So the key here is gating and modulation. Not just pain gating, it's actually gating and modulating. And that's an important and right there. And most importantly, these effects are often segmental and heterosegmental, meaning where you adjust matters neurologically, not just locally to. This doesn't mean to be sloppy with your technique, but it means the effects are not only localized, but they can extend out from there as well. So this gives you as a chiropractor a few really, really big advantages. It explains quote unquote why it still hurts without blaming the patient. So a patient that's pain went away and comes back, you don't have to dance around that. The pain doesn't either match the imaging or has come back. You can let them. So your nervous system has adapted. That is why your imaging does not match what you're feeling. Just because your imaging is clear and you have pain doesn't mean you're making it up. It means your nervous system, which we cannot see on these X rays, has adapted. And that pain is not equivalent to damage. It's actually a hypersensitivity even though the original injury has healed. And that can help build trust with people because it's a story that makes sense. And I say story, it's the truth. And it actually people can follow along when we talk about speaking at a patient level doesn't need to be quote unquote dumbed down. It just needs to be clear and somebody can understand, hey, you're in pain. There's nothing that we see on your imaging that would indicate why you're hurting. That's okay. That tells us it's your nervous system that's adapted and you're in the right place. So it supports a couple things. A neuroadaptive care plan and multiple visits because it's warranted. Central sensitization does not unwind or change after one visit. It's important to reassess over time. It's important to build in those education based care plans utilizing movement and adjustment strategies and then exposure. You hear me talk about fear, avoidance behavior. That's a big one with chronic pain. So helping people gain gradual exposure little bit by little bit. So this is not like let's get you out of the practice as quickly as we can because that's the kind of practice we are. This is about understanding. It's going to take time. Habits don't change. Neurons don't rewire in a moment. Frequently they don't so. And especially when you deal with chronic pain. So this is gradual exposure, it's care, it's reinforcement, it's education. And it positions you, this is the awesome part, as neurologically relevant. It's not alternative care. This is literally the latest in pain neuroscience. Utilizing evidence based pain modulation, utilizing non pharmacologic intervention. It's wicked low risks going to see you and it's really cost effective as well. So that really matters. And you can explain this in the same places we talk about week in and week out. Your report of findings explaining pain patterns using sensitivity, not degeneration. I'll say that one more time. You can explain pain patterns utilizing sensitivity and nervous system adaptation. Not necessarily just degenerative changes. You can normalize that pain will fluctuate and that's totally okay. That's actually what we expect with neuroadaptation. So just letting people know that, hey, when you work out, do you feel great the next day if you haven't worked out and get a muscle? No. You might be a little sore and it's gonna take quite a few times to build your muscles. The same thing takes place when we're talking about the nervous. You might feel a little better, you might feel a little bit worse. We wanna change that adaptation pattern, reduce the sensitivity and help you move without pain. Most people can be like, I understand that this is great information to put in your content marketing blog. Topics around chronic pain sensitivity, educational videos, reactivation campaigns. If you're looking for help with that patient pilot has it going on. Weekly emails that go out teaching your patient something great about themselves, their journey to better health and inviting them to come back. We've made that really, really affordable. You have a choice of over campaigns plus that you can choose from so it matches exactly the messaging you want going out to your patients. Check that out. SmartChiroPractor.com Also with patient retention, people who understand what's going on, stay longer, comply better and refer more. It's just the way it goes. So the big takeaway here is that chronic pain is not a tissue problem alone. It's often a nervous system problem in the adjustments that you deliver when positioned correctly. It's not just about the biomechanics, it's about changing over time, how the nervous system processes pain. And I loved this study for exactly that reason. I thought it was a great one. We'll drop a link down in the show notes and before we wrap up, I wanna give big shout out to Shockwave Centers of America. They're gonna hook you up with $500 off one of their shockwave units and a free cart. You can check them out at the link down in the show Notes. Fantastic resource to have in your practice for extremity complaints and beyond. So thank you so much for tuning in. Welcome to the Evidence Based ChiroPractor podcast in 2026. If you have not left a rating or review, I would love it if you would take a moment, scroll on down, tap how many stars, leave a line of inspiring text. I'll be sure to check out each and every one. And 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.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.