541- How Upper Cervical Adjustments Influence Movement Control in Chronic Neck 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. On today's episode, we are back with more brand new research all around the upper cervical spine and its effects when you adjust it on sensory motor control. Fantastic new exploratory randomized control trial. We're gonna dive into it and much more on today's episode. Before I do, big shout out to a few of our partners. Number 1, Leander Tables, $1,000 off their Series 950. 50. Use the code EBC2026. Visit them at their website down in the show notes. Give them a call. You can save $1,000. Additionally, Shockwave Centers of America, $500 off and a free cart if you're looking to add Shockwave in. Shockwave Centers of America has a complete line of devices. They've expanded recently, and the quality for the price is awesome. Check them out down below. Reach out to them. Let them know you're a listener and save some cash along the way. But as I said at the top, today we are talking about a study titled "Immediate Effects of Upper Cervical Spinal Manipulation on Cervical Sensory Motor Control in Individuals with Chronic Primary Cervical Pain." And again, this is an exploratory randomized control trial, brand new study. I'll drop a link, of course, down in the show notes. So if you've adjusted somebody specifically upper cervically and you know something changed, you know, it wasn't pain, it wasn't range of motion, but there was something else else going on, maybe they moved a little different, maybe they felt, you know, just again, quote unquote different, but in a good way, or maybe they were just more aware of their body, you might be thinking, well, I know I did something neurologically, but how do I explain that? And today's episode is about exactly that topic. So we're going to dive in again, brand new randomized controlled trial, and it looked at really what happens immediately after an upper cervical adjustment. So whether you're upper cervical specific or not, almost all of us deliver upper cervical adjustments at some point in time in our practice. And this study looked at it not in a way most studies do. They didn't measure pain. They actually measured how the brain and body are communicating. I love that. And what they found was pretty fascinating because it challenges what a lot of people expect expect to see after an adjustment. So let's get some of the basics down, then we'll dive into the results. So they recruited 35 individuals with chronic neck pain. Chronic, of course, you know, not acute, not subacute. Chronic, that means it is deep-seated. There probably are habits associated with things. There probably is fear avoidance behavior. And certainly the inflammatory response might have worked initially in the acute phase, but it didn't complete the process, aka They have chronic pain. You know, the problem wasn't taken care of. So classified as chronic primary cervical pain, meaning it's been there more than 3 months and is not explained by a specific structural diagnosis. And this is important because these patients don't just have pain, they almost always have sensory motor issues. So these things show up in your practice like poor proprioception, like decreased accuracy in movement, sometimes dizziness or instability, and a higher likelihood of this recurring in the future. So their nervous system basically is not doing a great job coordinating movement and positions. Makes me think of like NeckCare so much because their device measures a lot of these things in a super elegant manner. So the researchers in this study really wanted to know, hey, if we apply an upper cervical adjustment, What happens to the system immediately? And immediately being a key word, because this is not like weeks later, not after a care plan, but right away. And they measured it using something called a cervical movement sense test. So easiest way is kind of picture this. The patient has a laser pointer strapped to their head. They're sitting in a chair and in front of them is a zigzag line on the wall. Their job is to trace that line using head and neck movement. So again, I'll say like NeckCare does this in a really sophisticated fashion. This is pretty unsophisticated, but it kind of gets the point across. So instead of kind of guessing or eyeballing things, they're actually able to measure how accurate the movement was, how fast each individual moved, how long it took them to complete the process, and how well these things actually worked together. So they're really measuring how well the brain is controlling the neck and the cervical spine, and they measured this, importantly, before and immediately after the adjustment, and they split all of the participants into two groups. One group received a true upper cervical adjustment at C1-C2. The other group received a sham manipulation, so it kind of looked similar, it felt a little similar, but it didn't have the actual thrust. So it was a legitimately controlled comparison. So let's dive into some of the findings because this is where things get pretty interesting. So movement accuracy, we'll talk about accuracy first. Movement accuracy improved overall about 4%, but between the groups, it kind of just missed the level of being statistically significant. So the researchers couldn't confidently say that adjustments improved accuracy, but there definitely was a trend. Speed, that was a big one. After the adjustment, the experimental group, the ones who actually got adjusted, their movement speed increased— excuse me, decreased by 11%. Meanwhile, the control group, their speed increased by 8%. And the movement time, the control group got faster overall. They completed the task in less time, but in the adjustment group, no real change there. So if we simplify this, after an adjustment, you know, patients moved slower, but with a trend towards better control and accuracy. And that's really key because you might hear, wait, you know, slower, that sounds worse, but it's not. And it probably is better. And this kind of gets down to speed versus accuracy. And there's a fundamental concept in motor control called actually the speed accuracy trade-off. And it's exactly what it sounds like. The faster you move, the less accurate you are. The slower you move, the more precise you can be. It's completely logical. And it's exactly what happened in the study. So what likely happened here is after the adjustment, the nervous system didn't just move faster, it kind of moved better. So the group that got adjusted actually was able to kind of slow things down. They weren't rushing through the task anymore. And instead, they were very likely paying more attention to the movement, reducing movement variability, and prioritizing precision over just speed. And even though the accuracy improvement wasn't, you know, didn't reach the level of statistically significant, there was a clear trend upward. And that's important. So when we can compare that to the control group, they got faster, which is exactly what you'd expect from the repetition of doing it multiple times. but they just, there's no neurological shift. It was just motor learning. And that's the big insight from this study. The control group improved through practice. The adjustment group improved or changed, or it was influenced by adaptation. And that's a totally different mechanism. So how does this happen? What might be causing it? Well, the authors point to a few changes and one of them proposed proprioceptive input, another one muscle spindle activity, another one sensory motor integration. This probably all makes sense because all of those things are items we talk about as a result of getting adjusted pretty much week in and week out on this podcast. Proprioceptive input influenced or influence being, being influenced, muscle spindle activity influence, and also sensory motor integration. So because the upper cervical spine is totally loaded with mechanoreceptors. It's really one of the most neurologically dense areas in the entire body. So when you adjust that region, it's not just moving joints. You are literally altering the input that's going into the brain. And when that input is influenced or changes, the output, the movement, that changes too. And that's where this study, I think, becomes really, really valuable because it validates something that all of us have seen clinically for years, that adjustments don't just reduce pain. They change how people move, they change how people function, and they change how people adapt. So after an adjustment, your patient may not immediately kind of look better every single time in a traditional sense. They might actually look even a little more cautious sometimes, a little more deliberate, a little more controlled. And it's important to remember for you and for them that's not a step backwards. That's actually their nervous system kind of adapting and recalibrating. So if your entire eval is based on pain levels and range of motion, chances are you're missing a big piece of what's happening because this study shows unequivocally there are measurable neurological changes that are happening immediately, just like that, even before pain changes dramatically. So if you try to bring this to your day-to-day conversations, I think it can really elevate the value of what you do. And just letting people know, simple language, hey, after an adjustment, your body is recalibrating how it moves. That's why things might feel a little different at first. Simple language, but it's like, these are things that are missed so often. Just letting people know, hey, we're not just working on your pain. We're improving how your brain and body communicate, probably close to what many people say. Or if you're feeling a little more aware or controlled after you receive an adjustment with how you move, That's actually a really good sign. Again, all of those things, simple, clear, not jargon-based, but really, really powerful. So using lines like that, however you wanna take and interpret this research, but those are some examples. Using this in your report of findings by letting people know, re-exam specifically, you know, not just, oh, it looks like you're improving. A lot of people say that, but be specific. It looks like we're improving your coordination and control, not just your symptoms. That's a higher level conversation than just, am I out of pain yet? Can I get out of here? All right. Exercise progression. This study suggests something really important, that right after an adjustment, you may want to focus on accuracy-based movement, not just speed. So think about the rehab, the exercise that you're doing post-adjustment. Think about it in the vein of, are there slow controlled cervical motions I can do? Are there maybe guided tracking exercises? Are there eye-head coordination skills? Then later you can layer in speed. And again, for reactivations, just letting people know, even with a single adjustment, you can immediately change how your nervous system controls movement. That's a really compelling message and it's often overlooked. So this gives you an opportunity to bring in conversations in your practice around neurological control, conversations around movement precision, and conversations also around brain-body communication. And it's a totally different level of positioning than just pain relief alone. And this study didn't show dramatic pain changes. It didn't show faster movement, but it showed something that might be even more important. And that's a measurable change in how patients control movement immediately after an adjustment. So I loved this study. I hope you liked it too. I think there's a lot of take-home messages. If you want to dig deeper, I will drop a link down in the show notes so you can check it out right there. Before we wrap up, a few big shoutouts to a few other partners of ours. NovoPulse and their OA Recovery Program. You're seeing people every single day with osteoarthritis, and if you don't have a program for them, you're missing opportunity. NovoPulse makes it super, super easy, and it's a complete program, not just a device. Click down below, check it out, connect with their team. As well as Diabetes Reversal Group. Type 2 diabetes, big, big issue, and quite often it's something that we're just not getting involved in day in and day out with our patients, and it can slow and impact the results you're getting in your practice when people have type 2 diabetes. Diabetes Reversal Group, founded by a chiropractor, been around a long time, proven system that you kind of just outsource it to them. You can really just refer over to the experts, and it's a really nice program. Check it out, watch the video at the link below, connect with their team and learn more. Other than that, thank you so much for tuning in to this podcast. If you have not left a rating or review, I would deeply appreciate it if you would take a moment and do so. Whether it's your first episode or whether you've been tuning along for 10 years plus, thank you. As well as just saying thank you for being a chiropractor. Have a fantastic week in practice, and I will talk to you soon.

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