Chiropractic Adjustments and Autonomic Function | Podcast Ep. 157

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week's episode is all about the research and it is an emerging point in the research which is super exciting. We are talking about the adjustment on autonomic regulation and exercise performance. It's a brand new paper that came out in Spine in October of 2018 less than 60 days ago. And it's also a little bit of a preview podcast, meaning this is going to be the focus of a monthly research brief for all members of the Evidence Based Chiropractor. So if you are a member, you can look forward to having this in your inbox on the 25th or before. If you are not a member, then I'd encourage you to hop on board if you're looking to bridge the gap and build relationships with other healthcare providers in your community. Check out what we have going on@the evidencebasedchiropractor.com and if you hop in you will get this paper starting off December strong, but this week we are talking about a paper. It is going to be linked in the show notes. It is titled Spinal Manipulative Therapy Effects in Autonomic Regulation and Exercise Performance in Recreational Athletes. A Randomized Controlled trial. I'll say that one more time. Specific Spinal Manipulative Therapy Effects in Autonomic Regulation and Exercise Performance in Recreational Athletes. A randomized controlled trial. So this was that rct, a randomized control trial. It was double blinded and it was placebo controlled. So this is the top tier of what we are looking for. And as we know, the use of spinal manipulative therapy, AKA chiropractic adjustments has taken the sports world by storm. You cannot find a single athletic event that's being done at a high level without seeing a chiropractic as part of that healthcare team. As a matter of fact, earlier this week I put out a piece on Facebook highlighting a USA Today article citing, you know, chiropractic care in the NFL. And that has gone absolutely bonkers. With hundreds of shares, I think we're over 10,000 or more people reached, all organic, no money into it whatsoever. So this is a hot button topic, which is why I wanted to bring it as the December research brief and highlight it on today's podcast. Everyone from professional athletes to local crossfitters have sought spinal manipulative therapy or chiropractic adjustments as a way to reduce pain while improving function and performance. Those are really kind of the three tiers, I would say, right? Reduction in pain. You can't be performing well, if you're in pain, improving overall function and then this kind of a subset of that, which is sports performance and overall performance. So increased motoneuron excitability and altered central sensory processing have been a few of the proposed neurophysiological mechanisms that we've seen in the literature showcasing how a chiropractic adjustment might improve performance. And we've gone into that before. Right. Motor neuron excitability and again, that altered central sensory processing. Those are a few of when we look at where is the physiology meeting the neurology, how is this working together? Those are a couple things that are kind of emerging in the literature. And this recent study from spine, again, spine, nothing to do specifically with chiropractic. This is a top, top research publication. They found a moderate parasympathetic dominance after receiving spinal manipulation after receiving an adjustment. So again, your sympathetic is fight or flight. Your parasympathetic is rest and recover. And they saw a distinct shift from fight or flight to more of a relaxed state, if you want to think of it that way. Parasympathetic dominance after receiving an adjustment. So let's take a look at a few quotes from the paper and then we'll dive into a couple more key points. The researchers found, quote, single pre exercise SMT spinal manipulation session induced an acute shift towards parasympathetic dominance. That's just what we just said. Right. Second quote that I would like to highlight is the researchers found, quote, recent studies have observed an increased corticospinal excitability in electromyographic activity after a single SMT session. This is kind of harkening back to, I believe it was in the soleus muscle, if I'm not mistaken. But researchers found increased cortical drive after an adjustment that led to increased power or increased strength, as it may be said. So they're just citing previous papers. Pretty powerful stuff. And the researchers finally found, quote, a significant and very likely lower stress score was found in response to actual spinal manipulation compared to sham manipulation. A trend for significant and likely lower sympathetic to parasympathetic ratio and a likely higher natural logarithmic of root mean square difference between successive heartbeat intervals were observed with actual smt. Wow, that is quite a mouthful. But basically, what's that saying if I break that down. The researchers found a lower stress score. So people were going from fight or flight, right. Stressed out state to parasympathetic rest and relax, recover, rest kind of mode. So it's highlighting that they're talking about the balance of sympathetic Parasympathetic ratio, right? We're always in balance. It's never really all one or all the other. There's a balance there. And what they found was a shift again from sympathetic to parasympathetic. That ratio became greater, I guess, towards the parasympathetic side. And then the natural logarithm of root mean square difference between successive heartbeat intervals. That is a lot of, that's a big mouthful to get out. But basically what that's saying is what's going on between those heartbeats is the heart bump, bump, bump, bump, bump, or is the heart bump, bump, bump. And that's something that's looked at in the literature. And that's another thing that they found a significant difference in. So in this case, the researchers, after the specific adjustments that they give, they didn't see some sort of crazy power or strength difference or crazy performance difference. So what they did is they took a step back and said, well, why is that the case? We saw this shift from sympathetic, excuse me, to parasympathetic. But why didn't we, as some of these other people, why didn't we see that increase in performance? And they assert that the performance enhancement related to spinal manipulation may depend upon the segment mobilized with the thoracic spine being a region of specific interest. So they kind of talked about, again, sympathetic and parasympathetic. And maybe that's actually playing into some of this performance as well, and the cervical and lumbar being lumped together and then the thoracic being a point of interest where, wow, maybe if we only worked on the thoracic spine, maybe we would have saw differences in performance. Again, they're questioning this. This is emerging research. So they're throwing, you know, they find out one thing and then they throw out 10 questions, which is exactly what you want to have happen. So there aren't too many chiropractic practices that I know that don't see what I'll call athletes of all fitness levels, right? Whether it's the 80 year old individual that's just trying to be able to enjoy time with their grandchildren, get to the store and enjoy their later years, whether it's a 30 year old CrossFit competitor, whether it's a 25 year old semi professional, you name it, we all see individuals who really, regardless of fitness level, are looking for performance. And this where this study becomes exceptional, powerful in my mind is when we look at this and we see man again, what I'm gonna call almost outside in intervention, you're giving an adjustment on the skin, right. You're not diving into the person's body, you're able to give an adjustment. And that affects the central nervous system to the point where we actually see shifts in sympathetic to parasympathetic fight or flight to rest and recover. That's unbelievably powerful. We lump that onto what we previously know. Gating pain, decreases in pain, improved function and improved cortical drive, motor neuron excitability. Wow. It starts to become really dynamic with what we can do with our hands. And that to me is the power of a study like this and sharing it with the people in your community. We touch on many times. Right. Low back headache, neck pain. Because I think we should be seeing 99.9% of that market, get the red flags out of here, get those to the appropriate providers, maybe 99, if not 99.9. But we, we should be seeing a vast majority of those individuals. And until we are, I think it's important to continue that conversation on headache, neck pain and low back pain. But there is a time and a place to explore the possibilities of what's to come. And in a paper like this it does exactly that we've seen. There's such a melding of crossfit, of athletics, of fitness and chiropractic in the last five years. This is an important part of many chiropractors practices and being able to showcase autonomic regulation, being able to showcase performance changes to other healthcare, to the public of course, to your community and your audience of course, but also to other healthcare providers in a professional sense. You know, that's what we do at the evidence based chiropractor for all of our members. So again if 2019 you are looking to bolster, build and increase incoming referrals with other healthcare providers, we want to give you the system to do it. We have a done for you system and a done with you system. Try to make it exceptionally easy for you to make a decision, for you to get out there to the people in your community and to ultimately bridge that gap and build those relationships. But if you think it's gonna happen with an off meeting every once in a while, if you think it's gonna happen without having a system, I hate to tell you that's not going to be the case. You need to be systematic, you need to think about it strategically. That's what we do and I'd welcome you to become a part of it. But even if you are not ready for that at this point in time, I really appreciate you listening to the podcast. This year has been an awesome year for the podcast. If you have not left us rating or review on itunes, I'd encourage you to do that. That helps us reach more and more chiropractors and I hope you have a great holiday season. We will be back next week. We are not taking any time off, but as you lead into the holidays, I hope you have a fantastic week in practice and I will talk to you soon.

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