Can Chiropractic Adjustments Improve Strength, Balance, and Endurance | Podcast Ep. 264

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Happy New Year as we head in to 2021 today, we are back with the research and this is a really cool study. It came out in the Journal of Alternative and Complementary Medicine and it is all about strength, balance and endurance in active duty US Military personnel with low back pain. This was an rct, a randomized controlled trial and the results are pretty awesome. We're going to break down this study, make it actionable for you, highlight those best key quotes that you can take with you and utilize in your practice today. Before we get started, I want to give a shout out to everybody that's come on board. We had a last open enrollment for the Smart Chiropractor that wrapped up just last week and it was pretty awesome. We have a ton of new docs who got up and running with the Smart Chiropractor and because of that we were kind of coming down towards the end of the year. And I pulled out some of the stats from our smart chiropractor members over the course of 2020, which was challenged in many ways. I just wanted to highlight some of them because I was super impressed, super proud of our team and super excited for the docs who really have seen this in action. So with Smart Chiropractor, we automate marketing through social, through email, through in office, with streaming and all of that fun stuff. And in social, in 2020, we put out over 115,000 social posts for our members that resulted in over 7 million impressions on Facebook alone. That's incredible and I'm super proud to tell you that. Now here comes the real fun stuff that resulted in over 130,000 likes on those posts, over 8,000 comments, over 18,000 shares, and over 165,000 clicks on those posts on social over the course of 2020. Super impactful. Now let's get into email. We sent on behalf of our members over three and a half million emails that resulted in nearly one million emails opened. And in over 13,000 clicks. Those clicks could go to the online scheduler, those clicks might go to the website of the doc. There's a variety of ways that we push those clicks on the call to action, but man, these stats were super impactful to me. Super proud. And if you just came on board as a new smart chiropractor member, you can look forward to getting in on the action of those stats in 2021. We're also launching a directory, we're launching E commerce for docs. We are also launching the ability to have personalization on all of these posts. I'm probably letting the cat out of the bag on some of this stuff that we have in the product queue. But if you want to check this stuff out, head over to thesmartchiropractor.com but without further ado, let's talk the science. Today we're talking the effects of chiropractic care on strength, balance and endurance in active duty U.S. military personnel with low back pain. This was a randomized controlled trial and it came out again in 2020, just last year in the Journal of Alternative and Complementary medicine. So between 2001 and 2016, low back pain was the most prevalent musculoskeletal pain related diagnosis among active duty US military personnel. We used to see some military personnel at one of the multidisciplinary groups because of tricare and the patients would come in the active duty military and they'd be like, well, we'd say, what have you done for this? And they'd say the military's vitamin, which is Motrin. So this is not shocking to me that in the last 15 years or so, low back pain, the most prevalent musculoskeletal pain related issue. So what these researchers basically hypothesize is low levels of trunk muscle strength may increase the risk for or cause low back pain through altered activity and or movements to avoid potential pain. So low back pain appears to negatively affect the ability to sustain prolonged or repeated positions or movements and alter neuromuscular system factors influencing balance. So they're saying strength, they're talking balance, they're talking endurance. And they're basically saying, hey, low back pain really challenges all of these things. And if you're struggling with any of this, if you're struggling with strength, you might be at an increased risk for low back pain by altering your activity, by altering your movement patterns. And this is important stuff because when we think about strength, endurance and balance, they're not necessarily strength, probably the closest, but it's not necessarily what we always think of. With low back pain, we think mechanically but functionally these are super, super important aspects of it. Now, biological mechanisms underlying spinal manipulation, they're saying, are pretty complex, which we've explored for years on this podcast. And they're saying spinal manipulation may facilitate trunk muscle strength through motor neuron facilitation or disinhibition. Manipulation may also al sensory signaling, influencing changes in motor neuron output and reducing sensitivity to pain. I think of that like those thresholds Right. Resetting that pressure pain threshold so that it's normalized instead of being sensitized. That can make a huge difference in the perception of pain. And perception is reality. In a lot of these cases, as we see clinically day in and day out, if somebody is struggling, they're scared. Ultimately, the fear avoidance, that's a big deal. So how did this paper really analyzed it? They looked at over 100 individuals and they tested strength, balance and endurance. The isometric strength test basically required a semi squatting position while pulling on a handle. So it was sort of like lifting something by keeping your back straight. So that was the strength test. The balance test was really dominant foot, and they had to place both hands on the iliac crest and kind of see how long, you know, they could stay there. And then the Behring Sorensen test was utilized for muscle endurance. So they basically went through all three of these tests. They had a control group and they had a group that got an adjustment or got a spinal manipulation and they wanted to see, okay, well what were the differences post after going through an adjustment or a manipulation or was there any change whatsoever? What they found was pretty cool. They found mean maximum isometric pulling strength in the chiropractic care group increased by over 5 kg, whereas at deep decreased by over 7 kg in the wait list or the control group with a statistically significant difference in mean change between the groups. They also quote unquote found. We also found statistically significant differences in mean change between groups for the endurance and balance with eyes closed. So balance, they did eyes closed and eyes open. There's no real difference with eyes open, but with eyes closed, they found statistically significant differences. They found statistically significant difference in the endurance group and in the strength group. So all the way across the board, they concluded, quote, differences in mean change between groups were statistically significant, favoring chiropractic care. For the Roland Morris Disability Scale, average pain intensity over the past 24 hours, physical fear, avoidance behavior and pain interference. So not only were there statistically significant differences found with what they were looking at, strength, balance and endurance, but they also found a nice little side effect, so to speak, where there were statistically significant differences for people gut adjusted in Roland Morris disability scale in pain reducing, in fear, avoidance, behavior reducing, and in pain interference. So pretty much this was a clean sweep across the board that those individuals who received a an adjustment, chiropractic manipulation had a significant, statistically significant change in pretty much all of the important factors that you would care about if you were struggling with Low back pain. So the researchers also cited some other previous studies. Several clinical studies report increased lower and upper extremity strength immediately following manipulation at a single time point. These studies, mostly conducted with asymptomatic people, suggest that spinal manipulation related muscle strength change involves complex neurological phenomenon such as cortical spinal excitability. We've highlighted those papers on previous episodes where there's been strength increases post adjustment and they exactly as these researchers said, it was deemed a manifestation of neurological changes in the corticospinal column. So participants with low back pain receiving four weeks of chiropractic care in our trial showed statistically significant improvements in mean pulling strength by over 11 pounds compared with control group participants who decreased by over 16 pounds. The mean isometric muscle endurance measured with the Bering Sorensen test was improved by 3.3 seconds in the chiropractic care group compared with a 10 second decrease in the control group. So it's not only this is a really interesting point as well. It's not only that the chiropractic care group did better, the control group did significantly worse. So the gap really opened up. That's where a lot of the statistical significance comes in, is it's not just a incremental betterment after the adjustment. Right. It's like, okay, the mean group and the control group's data about the same. No, the control group got way worse, which is pretty normal. Right. When we look at individuals who have struggled or are struggling with low back pain, there's a cyclical nature to that and there's a little bit of if they're not doing anything to get better. Yes, there's a natural history that many people will get better over time. But we also know that between 10 to 30% go on to chronic disabling pain. And that stinks. So it's like this showcases the importance of getting care, getting the right care. It also shows that pretty much across the board, whether you're looking to increase strength, endurance and balance, which all can contribute incidentally to a lower risk of low back pain in the future, it also can take care of that pain at time of service. As we saw with the Roland Morris, as we saw with the fear, avoidance, et cetera. So super, super powerful researchers concluded in addition to the complex neurological processes associated with spinal manipulation that influence muscle function, mechanical forces of manual therapies may disrupt muscle spasm, hypertonicity and fibrosis between and within myofascial tissues in persons with chronic low back pa, improving the potential for normalized local joint and Tissue motion. And that really gets down to the takeaway message, getting in there, getting movement. I've said this time and time again, I'll continue to say it. I think about movement in three brackets or buckets. Regarding the spine, segmental motion, regional motion and whole body motion, if you are adequately moving, shaking, have fluid motion, good balance, great strength, endurance, the balance of strength and flexibility. Ultimately, regionally, segmentally and whole body, you're gonna be functioning probably at a pretty darn good level from a neuromuscular skeletal standpoint. However, if you have great whole body motion, but segmentally you're struggling well, you're gonna have a lot of compensation movements and that's gonna catch up to you over time. If you're moving great segmentally, but you never do anything whole body, you're probably gonna have cardiovascular issues. You're not going to be taking advantage of the fact that you have good segmental motion and regional motion sort of plays. Between both of those endpoints, between the segmental motion and between the whole body motion comes the regional motion of the cervical lumbar or pelvic spine. So these are very, very important things to keep in mind. Number one big takeaway here is the fact that strength, balance and endurance across the board have been shown to be improved after receiving chiropractic care. That's really important because it lowers the risk potentially of future issues and it helps you recover. Right now that combination is super powerful and when you take it one step farther and we can see very clearly that without care in the control group, things just got worse across the board. That's a powerful talking point and it is a powerful study to get out there into your community. We're going to queue it up in 2021 to get into for our evidence based chiropractor members to get out there and share this with other healthcare providers and in the community. I'm sure it's going to sneak its way into some of what we highlight through the smart chiropractor and site. And thanks to the research team that put this together. Fantastic paper, super actionable, very, very impactful. And I'll close by saying if you have not checked out the smart chiropractor, head over to the smart chiropractor.com be sure to check out what we have going on because it's awesome. We've helped a ton of docs and we intend on helping a ton more. In 2021 we closed out 2020, 2020 super strong. 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