537- The Impact of Spinal Adjustments on Stress Hormones

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're talking all about research and specifically the physiological changes of cortisol and oxytocin following manual therapy. This is a scoping review that just came out this past month. We're gonna talk about what it says, what we can take away from it, next steps, patient communication, and much more, all on today's episode. Today's episode is brought to you in conjunction with a couple of my partners, Leander Tables being one one of them, you can save $1,000 off their Series 950 using the code EBC2026 or visiting the page and connecting with their team. Let them know you're a listener and you'll save big. Additionally, Shockwave Centers of America, $500 off and a free cart. $1,500 in savings just for being a listener to this podcast. Thank you to both Leander and Shockwave Centers of America. Links are down in the show notes to connect with their team. As I said at the top, on today's episode is all about research, manual therapy, cortisol, oxytocin, What the research shows. So if you've been in practice a little bit of time or longer, you probably have had a pretty similar experience. Patients come in stressed, tight, overwhelmed, and after adjustment, they stand up and say things like, "Wow, I can breathe easier. That's exactly what I needed today. I feel a little bit calmer." And you think to yourself, is that like subjective? Is something happening physiologically? We've seen this with almost all of our patients, right, over the course of time we've been in practice. But the real question is, well, what's going on physiologically? So today's episode dives into that brand new piece of research. I'll drop a link down below, of course, that looks at exactly that question. So the researchers analyzed scientific literature examining what happens to two key hormones after manual therapy, cortisol, our primary stress hormone, and oxytocin, sometimes called the connection or bonding hormone. And the question they asked was really, really simple. Does manual therapy actually change these hormones in the human body? And the answer is pretty, pretty interesting, pretty fascinating. And more importantly, I'm going to say it gives us as chiropractors something really powerful, which is a physiological explanation for why patients often feel calmer, safer, better after the care that you deliver. So in an overview of this study is that it was released in 2026, Frontiers in Rehab Sciences. And the researchers wanted to understand something I think that all of us have talked about in chiropractic, massage therapy, pretty much in all manual therapy, which is that the patient feels more relaxed, less stressed, and more connected to their body after care. And the question is, what's the physiological mechanisms that are happening that might be able to explain this. Again, cortisol, primary stress hormone, uh, produced, uh, in, you know, in the HPA axis. And cortisol rises when the body perceives physical stress, psychological stress, inflammation, threats. And high cortisol for a short period of time can be really helpful. It's kind of like inflammation, right? You know, short-term acute inflammation is a part of the healing process. A short spike in cortisol is totally great. The real problem, just like chronic inflammation, is chronically elevated cortisol is linked to a lot of stuff and none of it good. Chronic pain, sleep disturbances, fatigue, depression, immune dysfunction, and much more. So really anything out there, specifically things that are non-pharmacological that can help regulate cortisol is really clinically meaningful and should never be overlooked. Now, oxytocin, kind of that bonding or connection hormone, it's involved in social bonding, trust. It signals safety kind of in the nervous system, stress reduction. So oxytocin also has some interesting neurological effects. It can downregulate— this is probably the most important— it can downregulate the stress response and modulate that HPA axis. So there's been growing evidence that show touch-based care and therapies may stimulate oxytocin release. So the researchers asked, do manual therapies like spinal adjustments, ding, ding, ding, massage, osteopathic manipulation, tactile therapy, do those items actually change the cortisol or oxytocin levels in humans? So to answer that question, they conducted a very large scoping review of really all the scientific literature out there. So their research team searched 5 major scientific databases: PubMed, Embase, Scopus, Web of Science, CINAHL. They looked for studies that met several criteria. The studies had to involve human participants. It had to include manual therapy interventions. No surprise there. Had to measure cortisol and oxytocin levels and had to report original data. Now, again, manual therapy did include sort of an array of things, spinal adjustments being one of them. But osteopathic manipulation, massage therapy, craniosacral therapy, tactile massage, all of that was included. So they screened over 2,300 studies and they found 72 studies that met that criteria. So just that alone tells us something that has actually been a pretty good amount of research. 72 studies, not nothing. So that's a pretty good amount of research exploring the hormonal effects of touch and manual therapy over the last couple decades. So Across all of that literature search, they found a few patterns. So first was cortisol changes were frequently studied. So cortisol was the most commonly measured hormone in the manual therapy research. And in many studies, cortisol decreased after care. So for example, multiple studies included in the review reported reductions in cortisol following massage, following osteopathic manipulation, spinal adjustments, craniosacral, So some studies showed reductions immediately after care. Other studies showed reductions over hours or days that followed. So this suggests to us that manual therapy may influence the stress response system. Really, really impactful because elevated cortisol, even if you're not like a functional medicine doctor or really do functional medicine in your practice, cortisol levels are a big deal. And somebody that's in chronic pain, somebody that's all of the symptomatology we discussed earlier, hyper-stressed, hyper-inflamed, chronic pain, nearly every one of those individuals have elevated cortisol levels. Like they're just living in like fight or flight. They're living in stress response. They're living, you know, minute to minute, so to speak. And that is impactful. That really wears people down over time. So anything that we can do and the care that we provide very clearly, as we're going to see and have started to unfold, The care that we provide when we can modulate and influence that, that is a massive quality of life improvement. Somebody that can step, so to speak, step back and be able to just chill out a little bit. Many people can't. They're in chronic state of stress, inflammation, and pain. Anything we can do to break that cycle, to decrease that, or to enable somebody to take a breather from that pattern is a massively meaningful thing that we provide. It's a massively meaningful benefit that we provide. So don't overlook that in terms of its real impact on people. So the second thing that the researchers noted was that the oxytocin research, it was limiting, limited, I should say, but it was pretty promising. So the evidence for oxytocin changes was smaller, but the findings that existed were pretty cool to dive into. Some studies reported increases in oxytocin following manual therapy, including spinal adjustments. So again, remember oxytocin, social bonding, emotional regulation, reduced anxiety. So when oxytocin rises, patients may experience things like a feeling of relaxation, a feeling of connection, a feeling of safety, which I think many of us observe clinically. And I tie this right in. I know it's like kind of one step removed, but like we talk about fear avoidance behavior, like when somebody feels connected, relaxed, and safe, this is when your rehab exercises, in my opinion, can really move forward even more meaningfully when they're not just having abject fear avoidance behavior the entire time. So, you know, these are impactful items here. Third thing they found was that the studies were pretty widely varied. So there was a lot of different treatment types, patient populations, you know, timing, sampling, et cetera. The hormones were measured in different ways and the timing varied as well. So, you know, there's a lot of variability, but the overall pattern still points to the same thing, which are that there were physiological responses following the care delivered. So there was a couple themes that come to mind with this. One was stress regulation, probably pretty obvious, but many studies did find that manual therapy influenced the HPA axis, and that is the body's main stress regulation system. So when HPA axis is overactive, cortisol rises, bad. But gentle touch, manual therapy can help downregulate that, which is good. So experimental studies out there actually showed touch stimulation can reduce HPA activity and activate oxytocin pathways in the brain. That's a big deal because you're really getting neuroendocrine signaling at that point. So second big thing or theme was cortisol decreasing, as we said. So several studies reported reductions in cortisol levels after care. And not, not every study showed these reductions, but there was enough out there that showed, you know, that showed that this was a trend, it was a pattern, and that manual therapy very likely modulates and regulates cortisol levels. And again, those oxytocin increases. So some studies observed that increases in oxytocin after manual therapy, including spinal adjustment. So That helps with pain modulation. It helps with emotional regulation. It helps with autonomic balance. So the manual therapy, the care, the adjustments that you deliver, again, it's not just about the joints and the muscles and that segmental unit. It is really influencing neurochemical signaling and even more specifically tied to stress and safety. We know it can impact pain, pain gating, all of those items. We know that there can be biochemical marker changes in the brain. But this is a really cool study because it's highlighting hormonal changes. And again, this is a big deal with the chronic pain population. And I think our chronic pain population is like over 30% or something like that. So this is a ton of people that are constantly dealing with elevated cortisol levels, that are constantly dealing with lowered oxytocin levels, and are just in a stage of suboptimal living. So of course, as I always say, it's like kind of the foundation. The first step is get out of pain. Not everybody's going to get 100% out of pain, but the first step is to reduce chronic pain and to break that cycle. Then to get people moving, right? Overcoming those fear avoidance behaviors and ultimately then helping them live their best life by guiding what their goals are based upon your findings. Your findings are going to tell you what's going on with them. Their goals are going to tell you where they want to get to. Your care plan is the guide. It's what's going to guide them from where they're at today to where they want to be in the future. And the better that you can communicate that, the better you can highlight that, the stronger your practice will be and the better your results will be over time. So patients, when they come in, I know you see this every day, when aftercare they're feeling a little less stressed, maybe even they saying, I'm a little bit more mentally clear, right? Those are measurable physiological changes. And the care that you're providing does impact stress response systems. It can impact, not every single time, but it can impact hormonal signaling. And again, those neurochemical pathways. So of course we address biomechanics, of course we address joint mobility, of course we address neuromusculoskeletal function, but we also are very likely influencing the nervous system's perception of safety and stress. And in a modern healthcare system and modern living today, I, there's potentially nothing more important to that, especially when we look at chronic stress, inflammation, poor sleep, fatigue. When you can help to regulate that, massively meaningful. So again, key points to bring this up: bring this up in your report of findings if applicable. In stress-related patient cases— headaches, neck pain, muscle tension, fatigue— there's a scientific explanation for how chiropractic may influence the results that they get. Marketing and messaging. You don't need to swing the pendulum all the way and go way overboard. Just help people understand a little bit clearer the benefits of the care that you provide. Also reactivation campaigns, my big favorite there with Patient Pilot. Really being able to get out there. And of course, in your communication to other healthcare providers. I can guarantee you there is like zero other healthcare providers that have any clue what you do in your practice. And most of them have no clue that you're actually taking care of the same people and co-managing them. Why? Because you haven't gone out there and told them. So that's what we do with MD Connection at the Evidence-Based Chiropractor, giving you the systems and processes to make it easy, super affordable to get out there and build referral relationships. It blows my mind, quite frankly, you know, real talk, that 99% of chiropractors seem to basically not care. That blows my mind. When you build relationships with other healthcare providers, it's not only really good for your business, these people come in, those referrals come in, ready to receive your care. You know, conversion's not an issue. They come in ready to receive your care. And when you build a relationship, those relationships can last a lifetime. Yeah, it takes a little work up front. You gotta kiss a few frogs to find your prince, as I always like to say. You gotta get out there and meet some people. But man, MD Connection makes it really systematized for you to be able to do that. And it's just wild to me that like 99% of chiropractors are not doing this. Because getting out there with other healthcare providers, whether it's an MD, a DO, a midwife, a doula, a sports med doc, it's really about about targeting those other providers who have your ideal patients in their practice. But using research like this, not to overstate what you do, but to really highlight the benefits of what you do and how you impact things is really meaningful and nobody knows about it. So thank you so much for tuning into this podcast. That's always the first step to get the knowledge. Second step, maybe the harder one, is to put it into action. And my goal is to give tools, products, services, and opportunities for you to do that and invite you to do every step along the way. On that token, two partners I wanna shout out, Diabetes Reversal Group. You can click on down below, watch the video, learn more about what they do. They can help you install a turnkey system, no selling on your team whatsoever, nothing you need to buy at all. Fantastic program, really knowledgeable, patented program that's been around a long time. Check out what they're doing. You have people coming in with type 2 diabetes every day into your practice. Just give them an option. Diabetes reversal program, super easy way to bring that into your practice, as well as the NovoPulse OA recovery program. Osteoarthritis— overwhelming majority of chiropractic patients have osteoarthritis. NovoPulse recovery program gives you not only the hardware, the unit, the tools, but also the software, the marketing to get out there and build more of that market in your practice. So thank you so much for tuning in. If you have not left a rating or review for this podcast, I will implore you, please scroll down and do so. It helps more More Docs Find Out. And whether this is your first episode or 500th episode, 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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