Can Spinal Adjustments Restore Brain Function? | Podcast Ep. 461

Foreign 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 brain plasticity following a lumbar disc herniation that gets treated with spinal adjustments. A great study, I think a foundational study that will set the stage for more papers to come, some take home messages and really interesting things and some really awesome items highlighted regarding how what we do through spinal adjustments can make impacts in brain plasticity. Before we get started, I'll say a few words about Turncloud minimalist design without being sparse, practical, yet being elegant. Turncloud's design is all about having the most efficient path in your day in a chiropractic practice. Strip away anything that's not essential. Make everyday function simpler. If that sounds like we what you'd want from an EHR head over to turncloud.com again that is turncloud.com but as I said at the top we are talking research. Title of the study is brain plasticity following lumbar disc herniation treatment with spinal manipulation therapy based on resting state functional mri. I'm gonna drop a link down in the show notes so you can check it out. Now this all starts obviously with those lumbar disc herniations, which is one of the most common causes for persistent low back pain. What is a lumbar disc herniation? We're pretty all well aware, but it is when the annulus fibrosis in the lumbar region, of course the nucleus pulposus, protrudes through that or with that annulus fibrosis into the spinal canal. What happens with this protrusion? Well, a, a variety of different things can happen, including chemical irritation of spinal nerve roots, mechanical compression of those nerve roots, pain disability and loss of functional ability or functional impairment. So there have been a variety of recent research studies that have highlighted that lumbar disc herniations not only affect the peripheral nervous system. When we think about those foraminal compressions, lateral recess stenosis, foraminal stenosis, it's kind of that peripheral compression is compressed at that segment and then the pain travels along that dermatome sclerotome. However you want to define it, it radiates or is radicular down wherever that nerve root travels. But there is new research highlighting that there can be influence not only on the peripheral nervous system, but also on the central nervous system anytime a lumbar disc herniation is present. We also know research has highlighted how effective Spinal manipulative therapy or spinal adjustments can be in taking care of an ARR of different health conditions. But definitely when we talk about chronic low back pain, disc issues, et cetera. As a matter of fact, spinal adjustments can decrease what they call bold B O L D signals in the brain, affecting regions such as the ins, the ACC and the left striatum. So that is a big deal because as of just a few years ago, that's when this research started to push forward it indicating that hey, there can be really big changes in terms of brain activity based upon what's going on with the spinal adjustment, which is absolutely monumental. This study focused on something that they called riho, as I'll highlight. And that's. What is that? Well, it's regional homogeneity. So that's, you know, a technical term, but that's what I'm gonna, I'm gonna reference RIHO a few times. Cause it's important as we get into this study and all of the previous research has really validated what they call the impact of SMT on functional brain activity with people that have low back pain. So the question has been, well, okay, there's no question that there's an impact. The question then becomes, can smt, can spinal adjustments restore aberrant brain function? And that is where this study was pushing forth. So this study aimed to do a few things. Enhance our understanding of abnormal brain activity in patients with lumbar disc herniation by analyzing RIHO in various frequency bands. Also hopefully provide some clinical evidence into frequency dependent abnormalities of spontaneous low frequency oscillations in this patient population. That's a lot of technical jargon, but basically what it means is when somebody gets adjusted, what happens? And specifically when we adjust individuals that have a lumbar disc herniation, there were 30 of those individuals and 30 healthy controls. What are the differences between the two at baseline with functional brain MRI and then post treatment with functional brain mri? The goal being what are the changes? And specifically what are the changes not only in terms of what happens for the people with lumbar discs after they get adjusted, but does it approach healthy controls? What are the baseline of healthy controls? And how do these two patient populations come together after receiving the care? So that's what this study was really after. There were no statistical differences in age, education or sex between the two groups. And they really, in this study had six sessions of SMT is how they were analyzing things. And this is a really big deal because we know the number one reason people visit a chiropractor for the first time is because of low back pain. We also know that there's a substantial amount of those individuals that have a lumbar disc herniation or have a disc herniation of the lumbar spine. So it's not only the pain and the dysfunction that are a challenge. There is, and we'll dive into this in the second half of this study. There's a pretty significant mental component, and it's why when we speak of the biopsychosocial model, there's just an important factor of fear, avoidance behavior. People are terrified. Am I ever going to be the same? Am I. Am I broken for life? Do I need surgery? These are the real thoughts that go through people's mind. So understanding how to communicate and how to set expectations is such an important part. And I'm just going to be blunt about it. It's a dramatically overlooked. Way too many providers. It's an overlooked component. Telling the truth is very important, but telling it in a way that people understand is even more important. And I know there are a lot of docs listening that just quite frankly, as I was talking about the jargon in this study, you speak jargon to the patient and they really don't understand what's going on. And indications that that's the case are difficult to see until it's too late. Meaning your patients are ending treatment and care against your recommendation. Well, that means they didn't understand what the care plan was and why it was there. And that's a really important component because as I've highlighted on this podcast many times when I was working in the orthopedic setting, you would be scared to learn about how the percentage of individuals that came in for a surgical consult that had a, quote, unquote, great experience with chiropractic a year ago, but it came back, quote, unquote. So now they're exploring surgical options. That's 100% a communication issue at that chiropractic practice. And I think all of us, 100% really should be consistently auditing. What are the conversations that we're having? How are we having those conversations? What can we learn to have more productive conversations? And that's something that quite often is overlooked. We're focused on new patient acquisition. We're focused on the latest and greatest technique. But we're rarely focused on the interpersonal communication of sitting knee to knee, heart to heart with a patient and having a conversation that they actually understand. So hopefully, this study maybe stimulates the idea of audit what you're saying how you're saying it when you're saying it, because all of those factors really matter with ultimately your patient compliance. And knock on wood, your patient compliance should be a direct reflection of them doing the right thing so they get the best result based upon your care recommendations. That's what it's all about. So this study analyzed 30 healthy controls, 30 people with lumbar disc herniations, six sessions of spinal adjustments. And the results indicated that following those spinal adjustments, the initially decreased rheo values in patients with lumbar disc herniations significantly increased. As a matter of fact, they approached a level of the healthy subjects. Great start. A similar trend was observed for the rho values in what they call the slow five frequency band. After those adjustments, the RIO values of patients with lumbar disc herniations with initially reduced activity approached the levels of healthy controls. On top of that, the RIO values of the left cerebellum, another brain area that differed between the two groups on the slow 4 frequency band was compared to and patients with lumbar disc herniations had significantly, significantly elevated RIHO levels post smt, with initially high values decreasing marketedly nearing those of healthy individuals. So all of those bits of data basically highlight the same big idea, which is the individuals that had lumbar disc herniations had rheo values which were pretty dramatically different than the healthy controls. And after they received spinal adjustments, they approached the exact levels of healthy controls. That is massively powerful. It continues to build our knowledge and understanding of the brain changes that can happen. It doesn't only matter at that segment with the biomechanics or with that pain gating or along that nerve root. This literally affects all the way up and down through that last cell that the nerve root connects to, all the way back up to the heart of the central nervous system, the brain itself. So these findings indicate patients with lumbar disc herniations exhibit spontaneous brain activity changes compared with healthy controls, aka lumbar disc herniation patients scanning differently on these functional MRIs and healthy controls. However, after those spinal adjustments, things start to shore up quite a bit. And these parts specifically of the brain that they were analyzing are also massively important. Why? Because the areas of the brain that they were scanning were crucial for emotional regulation, decision making, and behavioral control. So the part of the brain is the ofc. It's responsible for modulating emotional reactions, assessing the consequences of actions and, and adjusting emotional responses. This is like big flashing red lights around fear, avoidance, behavior changes, et cetera. After having A lumbar disc herniation. Right. And although the specific impact of the OFC with a lumbar disc herniation is a little bit unclear, there's no question lumbar disc herniations influence pain perception. There can be emotional regulation changes, both of which can be significant factors. Of course, with those disc herniations, emotional factors also can influence pain perception and coping mechanisms. And these findings highlight that lumbar patients with lumbar disc herniations exhibit significantly decreased ROHO levels in the L O, M, F G areas in both the conventional and slow 5 frequency bands compared with healthy controls. So this is all about understanding that what you do can make an impact again, not only locally, but regionally and holistically throughout the body. That is really impactful. And also understanding there's a lot to be, there's a lot more research to come in terms of understanding how a lumbar disc herniation plays into, I'm gonna say, the OFC changes in the brain. But what we do know is that there's influence and there's specifically influence when a spinal adjustment is given. And we've all had patients come in, we probably do, each and every day that are really struggling with lumbar disc herniations and understanding that that might have an influence on their emotions, understanding the consequences of their actions can change their understanding and assessments of that. And also that their emotional responses can really be influenced and differ based upon the fact that they're in abject pain. And not only that they're in pain, but that the lumbar disc herniation may be directly influencing, beyond pain alone, their ability to process information in the brain. And then the power that what we do with the chiropractic adjustment can influence that back the other direction, back to a normative state is massively powerful. Now, again, there's a lot to be learned and a lot of research still to come. And we don't want to over extrapolate, but what we do need to do is understand what's going on with the research currently. And even if it's not something that you're going to implement into a conversation regarding the emotions on a lumbar disc herniation today in your practice, understanding that what you do can make a positive impact in that is important. And also understanding that, hey, when a patient comes in again, I think we've all had these experiences where a patient comes in in abject pain and they are difficult and maybe even nasty, but once they start feeling better, their whole personality changes. We've all seen that. But to know that what we're doing is a really critical component of that transformation is impactful, it's powerful, and hopefully it makes you feel really good about what you're doing day in and day out with patients in your practice. So two primary symptoms of lumbar disc herniation, of course, pain and dysfunction. And research has indicated that people that have chronic pain, and particularly those with lumbar discs, are more susceptible to to experiencing symptoms like anxiety and depression, which can be attributed to ongoing pain, functional limitations, et cetera. So the fact that spinal manipulation could correct these abnormal changes is really, really impactful. It is really, really important. Their conclusion was Quote SMT was shown to partially normalize abnormal regional homogeneity in functional connections in patients with lumbar disc herniations. Specifically, changes in RIHO in the left cerebellum could serve as a sensitive indicator of SMT effectiveness. Overall, this study offers preliminary clinical evidence to indicate the impact of SMT on brain activity, highlighting the need for further research in this area. Very, very well said. Now, some of what this paper is pretty technical. I'll drop a link down below. I probably mispronounced a thing or two along the way because this is pretty technical when we get into the brain changes. But the big ideas are the big ideas, and those are individuals with lumbar disc herniations have differing brain activity than those individuals that are healthy or the healthy controls. The secondary component to that is this can not only affect pain and disability with the lumbar disc herniation, of course, but it also can affect what I'm gonna call brain processing emotions. And then the results of this study indicate that what we do with the spinal adjustment can influence and impact not only pain and dysfunction in the positive direction, but it also may have the ability to impact how we process pain, how we process emotion, and how we can make better decisions at the brain level. So really, really important study, really impactful study, A little bit technical. I hope you enjoyed it. If you have not left a rating or review for this podcast, please do so. You can scroll on down if you're listening on Mob Tap. How many stars leave a kind word or two? I would really, really appreciate that. I know I get thousands of docs listening each and every week and I'd love to hear from you and get your feedback if you've been enjoying what you're listening to. Additionally, before we wrap up, I want to say a few words about neck care, the best objective assessment tool for the cervical spine neckcare.com, i'll drop a link down below. Reliable assessments and exercises for neuromuscular control, Proprioception, Range of motion, and Sensory Motor integration. It is one of the slickest hardware and software packages out there. If you follow me on Instagram or YouTube, you probably have seen the software and the hardware itself. But if you have not, or if you have and you're ready to bring this into your practice, head over and start a conversation with the team@neckcare.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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