562- New Evidence on Cervical Adjustments: Immediate Effects on Pain and Muscle Response

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. This week we are back with more research all around the clinical and neuromechanical effects of a cervical adjustment. Cool new study that came out. We'll dive into it, talk about clinical pearls, take-home messages, and much more. Before I do, big shout out to the Icelandic Chiropractic Association. I was up there this past weekend, did a one-day— I guess I guess sort of masterclass on some marketing, some imaging review research. Absolutely beautiful country, fantastic group of chiropractors. Thank you so much for having me up. As well as some of our partners, Leander Table, $750 off their Series 950. Get that flexion distraction going. EBC 2026, as well as Shockwave Centers of America, $500 off and a free cart. Big savings for being a listener. We'll drop those links. Connect with their team, get the savings, ask questions. Thank you to both Leander and Shockwave for being partners. As I said at the top, today we are talking research. And we're going to settle maybe an argument. Maybe if you had a friend in physical therapy or a patient scrolling social media, when someone walks in with chronic neck pain, does it matter whether you thrust or mobilize? You've probably heard both sides. You know, there's one camp out there that may say, hey, it's all manual therapy. It all works the same, pick what you want. The other camp, I'm gonna say my camp, a high velocity thrust are completely— a high velocity thrust is totally different than a mobilization. And of course they do different things. I think the research has been pretty clear that something different happens when you get into the paraphysiological space when there's a high velocity move. But we're gonna dive into this research and see what it says. So this is a brand new study. They put the same patient on the table for both, same people, same level. One day, an adjustment, a few days later, immobilization, EMG sensors on their muscles and pressure under the clinician's hands measuring how much force went in. So this study published 2026, Chiropractic and Manual Therapy, we'll drop a link down in the show notes. The title officially is Immediate Clinical and Neuromechanical Effects of cervical spine manipulation compared to cervical spine mobilization among individuals with chronic neck pain, a randomized mechanistic crossover trial. And again, we'll drop that link down below. This study is a big deal because neck pain is a big deal. The authors point to the global burden of disease. That dataset shows chronic neck pain prevalence jumped about 77%.

Wow.

Between 1990 and 2020. And it's projected to rise over another 30% by 2050, mostly because the population is aging. So what is point prevalence? We'll highlight that really quick. Point prevalence is how many people of any random group have something going on at any specific point in time. So if you grabbed 100 people and you found that 5 out of the 100 had neck pain, you'd say it's 5% point prevalence. If you could grab any random 100 people and have about 5 have neck pain, that would be point prevalence or prevalence. So in 2019, the Global Burden of Disease rankings, neck pain came in 11th out of 369 conditions for years lived with disability. So it's causing a big deal, 11th out of nearly 370. So it's, you know, part of what our bread and butter is as chiropractors. And it's Only getting bigger over time. Clinical practice guidelines, what do they say? Well, they've recommended both spinal adjustments and spinal mobilization as part of a multimodal approach to taking care of people that are struggling with chronic neck pain. So quick definitions, I think we're all on the same page, but manipulation or adjustment, high velocity, low amplitude, fast one-shot directly into the joint. Mobilization, slower oscillating repeated movement— movements with—

Very good.

variable amplitude, no thrust. So important to kind of highlight that from the beginning. And in research, that can become sort of a challenge at times. There's a lot of research that lumps both of these under spinal manipulative therapy. And when you do that, I think you blur the lines pretty substantially. You can't tell whether the thrust is doing something or the mobilization or vice versa. So this study really separated those. And it was— the goal was to directly compare the immediate clinical and neuromechanical effects of a cervical adjustment versus cervical mobilization in people, of course, with chronic neck pain. So this was a randomized crossover trial. So that means every participant got both treatments. 89 people with chronic mechanical neck pain, chronic at least 12 weeks long, came in for 2 sessions, 72 hours apart. They were randomly assigned to get either of the treatments first and then the other one second, and the randomization was stratified by age and sex, so the group stayed pretty much balanced throughout. So the beauty of the crossover design is that everybody serves kind of as their own control. You're not comparing, you know, like Susan to Bob, right? You're comparing Susan to Susan after thrust or after mobilization, and that cuts out a ton of noise. So average age in this study, 35 years old. 65% of the individuals were female. The age range, 18 to 65. Neck disability index, 79% had mild to moderate disability and about 20% had moderate to severe. So just important to keep that in mind. At each session, a chiropractor did a quick history and exam, screened for any red flags. And found and marked the most painful cervical level. Now that same level got taken care of or treated in both sessions. So here's what kind of each session looked like. The manipulation, the adjustment, single HVLA thrust, posterior to anterior delivered to the targeted facet joint with the patient lying on their back delivered by chiropractors. Sounds like a diversified adjustment to me. Mobilization, 30 seconds of repeated posterior to anterior mobilization, On the spinous process with the patient lying face down, delivered by chiropractors, physios, and other manual therapists. And here's a cool detail. The clinician had a thin, like flexible pressure mat between their contact and the contact point in the patient's neck, like their own personal contact point in the patient's neck. So under the index finger, typically for the thrust and under the thumbs for the mobilization. That pressure mat recorded the force. 200 times per second. So they knew exactly how hard and how fast each treatment was being delivered. And before and after each treatment, they measured 4 things: pain on a 0 to 10 scale, active cervical range of motion with a digital inclinometer, pressure pain threshold using an algometer, which basically, you know, how much pressure it takes before the pressure turns into pain, and grip strength with a hand dynamometer. So During the treatment, they recorded muscle activity with surface EMG on 3 muscles, bilateral, both sides, the SCM, upper trap, and then they threw a curveball, the tibialis anterior. That shin muscle was sort of that remote check to have something, so to speak, offsite. So if something shows up there, you're looking for more global changes rather than just local neck. Pretty cool addition in my opinion. So a few design details. To show that this was done carefully, the person measuring the outcomes was blinded. They literally left the room when the treating clinician came in and only came back in when the patient was sitting up. The treating clinicians were blinded to the hypothesis, and the patients filled out an expectation questionnaire before each session so researchers could check whether they expected, the patients that is, one treatment to work better. So expectations were the same for both, inevitably. So what they couldn't blind was the patient because they're using the same patient, of course. So let's dive into some of the stats and the findings. So first, pain. Chiropractic adjustments reduced pain about twice as much as the mobilization. I'll repeat that. Chiropractic adjustments reduced the pain about twice as much as the mobilization. Pain dropped an average of 0.79 points on a 10-point scale after an adjustment versus 0.37 points after mobilization.

That's huge.

That difference was statistically significant. And that's pretty impactful. Now, second, range of motion. Both treatments improved range of motion in every direction, and there was no significant difference between them. Flexion and extension went up from 4.6 degrees after manipulation and about 3.7 degrees after mobilization. So both had clinically meaningful impact. And ultimately, the adjustment still kind of beat it, so to speak. Lateral flexion beat mobilization, that is. Lateral flexion went up 4 degrees after adjustment, 2.6 after mobilization. Rotation, 1.6 after an adjustment, 1.4 degrees after mobilization. So literally in every single category, the adjustment for range of motion beat the mobilization, and it of course beat the mobilization in terms of pain reduction.

Yeah.

Now, third, and this was the big mechanistic headline, muscle response. EMG activity in the neck muscles was dramatically higher during the adjustment. In the SCM, it was roughly 6 times higher. In the upper trap, 3.5 times higher, both sides. Pressure pain thresholds, a little bit more messy. Some increases, some decreases, pretty inconsistent. Grip strength, on the right side, grip went down slightly after both treatments.

Hmm.

But the threshold for a real change, you know, basically is 6 kilograms and the change was 1.1. So long story short, grip strength, nothing really to note there. 6th, I know there's a lot of these, 7 of them total. 6th, patient's global impression of change favored the adjustment, not by a ton, but by a little bit. And 7th, no adverse effects with either one. So the short version is— The adjustments, you know, kind of hit the muscles harder, nudged pain down more, and ultimately provided more benefit in every category measured, which I think is really the big take-home message. And to me, that's impactful because you hear a lot of times in the research manual therapy, and it can mean a lot of different things. That's why I try to highlight when the research cites specifically a chiropractic adjustment, spinal adjustment, spinal manipulation. I try to say that specifically.

Yeah.

Because something— when you're doing the manual therapy umbrella, it's going to take into account, as we've talked about, everything. So it could be mobilization or it could be an adjustment. I believe because of what I've seen and read in literature over a decade, probably thousands of studies at this point in time, something different happens when an adjustment was delivered, is delivered. And this study, I'm going to say, nudges that even farther down the road.

I—

still trying to figure out. I think the researchers are as well. Okay, what, what is that something different? Well, it's a lot of, it's a lot of different things. It's a lot that, that adds up in there. But whether it's the biochemical marker changes, whether it's cortical drive changes, whether it's facet gapping, you know, there's a host of things that go on. I'm oversimplifying it a little bit, but I just think when you do something that's high velocity, So big impact, high velocity, and you are able to get into that paraphysiological space. Those are the 2 things where different things happen than if you're just going through a mobilization or a guided range of motion. And that is something we should be using to our advantage as chiropractors is understanding this is meaningful what we do. It's impactful. And hey, you might sometimes choose to do mobilization. Sometimes you might choose to deliver an adjustment. Sometimes you might choose to do both.

Yeah.

That's going to be based upon, of course, your plan of care. What's your care plan? What are the patient's goals? What are your clinical findings? What is the best technique and course of action to deliver them the results that they're after? But ultimately, it is important to keep in mind— I'm going to say keep in mind and respect— the fact that when you deliver an adjustment, I know for us, especially if you've been doing it quite a few years, you're like, this is— it's a skill and you get good at the skill. So it Feels easy. You're like, okay, somebody walks in with neck pain, low back pain. I'll deliver an adjustment. It just takes a minute or two. It's easy for me to do. I know exactly what I'm doing. That's a great feeling. That's actually skill at a very high level. But don't forget about the fact that it's skill at a high level. And when you deliver that adjustment, even though it might seem relatively straightforward for you to deliver that adjustment, even though it might not take That much time. There's a lot that's gone into you. I think of the famous Picasso quote where somebody walks up to Picasso and says, you know, Mr. Picasso, would you mind sketching something on this napkin for me? And Picasso sketches something in 10 seconds, hands it back, and says, you know, that'll be $10 million. And the patient says, that just took you 10 seconds. He says, my son, that's taken me my entire life. And I think the same thing holds true with when you deliver an adjustment. There's an art and a science. Truly, there's an art and science to when you deliver that adjustment. And while it might only take a moment, every adjustment that you've ever delivered in your career before that has led up to that time. And that is something, especially in this case, we're talking about the human body. We're talking about really changes that can affect things locally, segmentally, regionally, through the CNS, through the peripheral nervous system. All of those items are being impacted when you deliver that adjustment. And I think it's just important for us to take a moment and say, Yeah. Wow, that is awesome. And we should absolutely respect that. We should not think about that in terms of how can we sell that at the cheapest we possibly can, but ultimately, how do we deliver that in a way that provides the most value? And number one, you have to stay in business. So there's a value threshold and price that matters. But then also, how do you package that in a way that patients can not only afford it— that doesn't mean cheaper always— but that they can also get the best results possible? To me, some of the best practices that I've seen have figured that out. And some of the practices that struggle continue to cheapen and they try to build volume over value. And ultimately the math stops working and you end up in a troubled situation. So not to get off topic from the research, but I think it's just important to point that out and made me think of it as I went through this research. And as we wrap things up today, big shout out to the Rehab Fix Hybrid Program. If you're looking to help people beyond the 4 walls of your practice, in addition to the 4 walls of your practice, Grant Elliott has put this together.

Yeah.

He has done it himself. He is happy to show you the numbers. This is a guy who is not afraid to talk the math of things, and I respect that. So if you're looking to build and grow your business beyond the 4 walls of your practice, the Rehab Fix Hybrid Program is a great way to do it. Connect with Grant and his team. I'll drop that link down below, as well as the NovoPulse OA Recovery Program. Osteoarthritis, it is happening in big numbers, and if you don't have a recovery program, you're probably missing out. Many people have heard of shockwave, they've heard of spinal decompression, But OA recovery programs are easy to install. There's a massive market for it. And it can be done in a way that can make you feel a little happy about what you're doing and proud of what you're doing in your practice, as well as CarePlan Pro. Care plans, memberships, and concierge that sell themselves. CarePlan Pro, we have like sprinted to over 400 docs on this platform very, very quickly. And the feedback has been awesome. So even if you are a doc that says, I don't do care plans, if you recommend more than one visit at a time, even on the first visit, you are doing a care plan. Care plan does not mean 36, 46, 74, 7,000 visits. It means more than one visit at a time. And Care Plan Pro makes it easy to package that in a way that patients understand. Step up your follow-up and communication with automation. It is a sales layer. It is not a replacement for your EHR. So if you'd like to help more people and make more money, careplanpro.ai, or shoot me a message, jeff@theevidencebasedchiropractor.com. Other than that, thank you so much 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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